Provider Demographics
NPI:1548391162
Name:ALASKA OPTICAL SERVICE,INC
Entity Type:Organization
Organization Name:ALASKA OPTICAL SERVICE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:WARD
Authorized Official - Suffix:III
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:907-278-2020
Mailing Address - Street 1:554 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2620
Mailing Address - Country:US
Mailing Address - Phone:907-278-2020
Mailing Address - Fax:
Practice Address - Street 1:554 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2620
Practice Address - Country:US
Practice Address - Phone:907-278-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK0074332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOPO740Medicaid