Provider Demographics
NPI:1295864601
Name:COOK INLET EYECARE INC
Entity Type:Organization
Organization Name:COOK INLET EYECARE INC
Other - Org Name:COOK INLE EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEV
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-276-1021
Mailing Address - Street 1:534 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2208
Mailing Address - Country:US
Mailing Address - Phone:907-276-1021
Mailing Address - Fax:
Practice Address - Street 1:534 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2208
Practice Address - Country:US
Practice Address - Phone:907-276-1021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK266788156FC0800X, 156FX1800X
156FC0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOP1124Medicaid
AKOP1124Medicaid