Marvin R. Acquistapace, O.D.
Individual provider Active NPI Optometrist · Fairbanks, AK
NPI 1679678809 · NPPES record last updated Nov 3, 2017
Key facts
- NPI
- 1679678809
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 222 (AK)
- Practice address
- 116 Minnie St
Fairbanks, AK 99701-3006 - Phone
- (907) 456-7760
- Fax
- (907) 451-7916
- NPI assigned
- Sep 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- University of California - School of Optometry, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
145 S Santa Claus LN
North Pole, AK 99705-7754
Phone (907) 385-3937
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100316000223 | AK | Practitioner - Optometry | 7618002676 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 222 | AK | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Pole Eyecare LLC | Optometrist | Current |
Accepting new patients |
Locations
145 S Santa Claus Ln
North Pole, AK 99705
Phone (907) 385-3937
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 222 | AK | Yes |
Addresses
Primary practice location
116 Minnie St
Fairbanks, AK 99701-3006
Mailing address
750 Eastview Dr
Fairbanks, AK 99712-2638
Phone (907) 978-2734
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OD0014 | Medicaid | AK | |
| 1023203 | Medicaid | AK |
Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.