Provider Demographics
NPI:1346438629
Name:STRALKA, STEPHEN M (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:STRALKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E NORTHERN LIGHTS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2814
Mailing Address - Country:US
Mailing Address - Phone:907-276-3937
Mailing Address - Fax:907-278-3937
Practice Address - Street 1:401 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2814
Practice Address - Country:US
Practice Address - Phone:907-276-3937
Practice Address - Fax:907-278-3937
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK5707170001OtherDMEPOS SUPPLIER NUMBER
AKOD11221Medicaid
AK5707170001OtherDMEPOS SUPPLIER NUMBER
AKK160480Medicare PIN