Provider Demographics
NPI:1033323225
Name:CHUGACH EYE CLINIC AND OPTICAL, INC.
Entity Type:Organization
Organization Name:CHUGACH EYE CLINIC AND OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAGGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-694-2020
Mailing Address - Street 1:10928 EAGLE RIVER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8078
Mailing Address - Country:US
Mailing Address - Phone:907-694-2020
Mailing Address - Fax:907-694-5989
Practice Address - Street 1:10928 EAGLE RIVER RD STE 102
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8078
Practice Address - Country:US
Practice Address - Phone:907-694-2020
Practice Address - Fax:907-694-5989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK95152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK400601400601OtherBLUE CROSS BLUE SHIELD #
AKOP0095Medicaid
AKU43062Medicare UPIN
AK400601400601OtherBLUE CROSS BLUE SHIELD #
AK0918420001Medicare NSC