Provider Demographics
NPI:1124397682
Name:HOMER EYECARE LLC
Entity Type:Organization
Organization Name:HOMER EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PETER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-235-7745
Mailing Address - Street 1:3726 LAKE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7663
Mailing Address - Country:US
Mailing Address - Phone:907-235-7745
Mailing Address - Fax:907-235-7710
Practice Address - Street 1:3726 LAKE ST
Practice Address - Street 2:SUITE A
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7663
Practice Address - Country:US
Practice Address - Phone:907-235-7745
Practice Address - Fax:907-235-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK306152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty