Provider Demographics
NPI:1730305509
Name:PENINSULA EYE CLINIC, APC
Entity Type:Organization
Organization Name:PENINSULA EYE CLINIC, APC
Other - Org Name:PETER E CANNAVA MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:CANNAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-262-4462
Mailing Address - Street 1:161 N BINKLEY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669
Mailing Address - Country:US
Mailing Address - Phone:907-262-4462
Mailing Address - Fax:907-262-3914
Practice Address - Street 1:161 N BINKLEY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669
Practice Address - Country:US
Practice Address - Phone:907-262-4462
Practice Address - Fax:907-262-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1040Medicaid
AKMD1040Medicaid
C97027Medicare UPIN