Provider Demographics
NPI:1316120405
Name:ALASKA VISION CENTER, INC.
Entity type:Organization
Organization Name:ALASKA VISION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:GEERING
Authorized Official - Last Name:MATHESON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-586-9864
Mailing Address - Street 1:800 GLACIER AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1845
Mailing Address - Country:US
Mailing Address - Phone:907-586-9864
Mailing Address - Fax:907-463-2679
Practice Address - Street 1:800 GLACIER AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1845
Practice Address - Country:US
Practice Address - Phone:907-586-9864
Practice Address - Fax:907-463-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK148152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOD1481Medicaid
AKOD1481Medicaid
AK153121Medicare PIN