Provider Demographics
NPI:1194062000
Name:OPTIHEALTH MEDICAL CLINIC
Entity type:Organization
Organization Name:OPTIHEALTH MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-350-8903
Mailing Address - Street 1:1000 OMALLEY RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3032
Mailing Address - Country:US
Mailing Address - Phone:907-350-8903
Mailing Address - Fax:
Practice Address - Street 1:1000 OMALLEY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3032
Practice Address - Country:US
Practice Address - Phone:907-350-8903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6967261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care