Provider Demographics
NPI:1699950998
Name:BRIAN D CIN OPTOMETRIST LLC
Entity type:Organization
Organization Name:BRIAN D CIN OPTOMETRIST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-333-6040
Mailing Address - Street 1:6901 DEBARR RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1806
Mailing Address - Country:US
Mailing Address - Phone:907-333-6040
Mailing Address - Fax:907-333-6619
Practice Address - Street 1:6901 DEBARR RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1806
Practice Address - Country:US
Practice Address - Phone:907-333-6040
Practice Address - Fax:907-333-6619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKOPTOMETRY 171261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKVG0004Medicaid
AKVG0004Medicaid