The Villiage Store Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

97 Issued in AK

Legal business name

THE VILLIAGE STORE INC

Practice address

3455 Rewak Dr
Suite 102
Fairbanks, AK 99709

Phone

(907) 474-8695

Fax

(907) 474-8727

NPI assigned

Mar 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

James Curtis Graves, ODNPI 1447657200

Title

President Owner

Phone

(907) 474-8695

Specialties & licenses 1

Addresses

Other names 1

• Fairbanks Optometric Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James Graves, O.D.

  • Optometrist
  • Fairbanks, AK
  • NPI 1447657200
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659400596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3455 REWAK DR",
            "address_2": "SUITE 102",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99709",
            "telephone_number": "907-474-8695",
            "fax_number": "907-474-8727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 REWAK DR",
            "address_2": "SUITE 102",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99709",
            "telephone_number": "907-474-8695",
            "fax_number": "907-474-8727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE VILLIAGE STORE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "CURTIS",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "907-474-8695",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AK",
            "license": "97",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairbanks Optometric Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maria Stoianova Terziyska, LMT
• Timothy Walter Teslow, MD
• Leslie Rae Tester
• Tiana R Teter, MSW
• Vicki Thayer
• Adam Thieman
• Matthew Thiemet
• Lisa Kathleen Thoene, PA-C
• Caleb Luna Thomas
• Christian Thomas

• Optometrist in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Optometrist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.