Provider Demographics
NPI:1508281551
Name:NORTH POLE OPTICAL, INC
Entity Type:Organization
Organization Name:NORTH POLE OPTICAL, INC
Other - Org Name:NORTH POLE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROCKELSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DISPENSING OPTICAIN
Authorized Official - Phone:907-488-9462
Mailing Address - Street 1:PO BOX 55309
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-0309
Mailing Address - Country:US
Mailing Address - Phone:907-488-9462
Mailing Address - Fax:907-488-2170
Practice Address - Street 1:145 S SANTA CLAUS LN
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-7702
Practice Address - Country:US
Practice Address - Phone:907-488-9462
Practice Address - Fax:907-488-2170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK49156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty