Provider Demographics
NPI:1437259678
Name:MESSERSCHMIDT, FORREST BATES (OD)
Entity Type:Individual
Prefix:
First Name:FORREST
Middle Name:BATES
Last Name:MESSERSCHMIDT
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 1:8800 GLACIER HWY STE 118
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8079
Mailing Address - Country:US
Mailing Address - Phone:907-789-1855
Mailing Address - Fax:907-789-1881
Practice Address - Street 1:8800 GLACIER HWY STE 118
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8079
Practice Address - Country:US
Practice Address - Phone:907-789-1855
Practice Address - Fax:907-789-1881
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKODO134152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKODO134OtherSTATE #
AKODO134OtherSTATE #
AK0000PHGBSMedicare ID - Type Unspecified