Provider Demographics
NPI:1588021232
Name:OPTICAL MATCHMAKERS/HOME OPTICS LLC
Entity Type:Organization
Organization Name:OPTICAL MATCHMAKERS/HOME OPTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEEHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:907-688-4979
Mailing Address - Street 1:11723 OLD GLENN HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7750
Mailing Address - Country:US
Mailing Address - Phone:907-688-4979
Mailing Address - Fax:866-929-6470
Practice Address - Street 1:11723 OLD GLENN HWY STE 201
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7750
Practice Address - Country:US
Practice Address - Phone:907-688-4979
Practice Address - Fax:866-929-6470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK155156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty