NPIMap

Organization Active NPI

Eye Clinic of Fairbanks, Inc

  • Ophthalmology Physician
  • Fairbanks, AK
National Provider Identifier
1689903965
Registry record updated Jun 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
292621 Issued in AK
Legal business name
EYE CLINIC OF FAIRBANKS, INC
Practice address
116 Minnie St
Fairbanks, AK 99701-3006
Phone
(907) 456-7760
Fax
(907) 451-7916
NPI assigned
Dec 15, 2009
Last updated
Jun 22, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2012

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

Authorized official

Name
Ronald W. Zamber, M.D.NPI 1831177187
Title
President
Phone
(907) 456-7760

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 292621 AK
Optician 156FX1800X 292621 AK
Ophthalmology Physician 207W00000X 292621 AK Primary

Addresses

Primary practice location

116 Minnie St
Fairbanks, AK 99701-3006

Mailing address

116 Minnie St
Fairbanks, AK 99701-3006
Phone (907) 456-7760

Other identifiers 2

IdentifierTypeStateIssuer
A0330OtherAKBLUE CROSS
MDG576MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040323000706 AK Part B Supplier - Clinic/Group Practice 7719878370 Receives reassigned benefits from 9 practitioners
2 other NPIs on this enrollment
Practice locations: Fairbanks, AK
O20100930083544 AK DME Supplier - Physician - Ophthalmology 7719878370 Practice locations: Fairbanks, AK

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1919 Lathrop St
Ste 103
Fairbanks, AK 99701
Phone (907) 456-7760

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1260835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340323200000",
    "number": "1689903965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 MINNIE ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997013006",
            "telephone_number": "907-456-7760",
            "fax_number": "907-451-7916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 MINNIE ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997013006",
            "telephone_number": "907-456-7760",
            "fax_number": "907-451-7916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CLINIC OF FAIRBANKS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-15",
        "last_updated": "2012-06-22",
        "status": "A",
        "authorized_official_last_name": "ZAMBER",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-456-7760",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AK",
            "license": "292621",
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "AK",
            "license": "292621",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "AK",
            "license": "292621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "A0330",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MDG576",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.