Dewayne Halverson, O.D.
Individual provider Active NPI Optometrist · Anchorage, AK
NPI 1528188596 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1528188596
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 061 (AK)
- Practice address
- 3744 Lake Otis Pkwy
Anchorage, AK 99508-5208 - Phone
- (907) 561-5118
- NPI assigned
- Mar 31, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 061 | AK | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4352 | CA | |
| Optometrist | 152W00000X | 061 | AK | Yes |
Addresses
Primary practice location
3744 Lake Otis Pkwy
Anchorage, AK 99508-5208
Mailing address
3744 Lake Otis Pkwy
Anchorage, AK 99508-5208
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OP0061 | Medicaid | AK |
Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.