Provider Demographics
NPI:1740421759
Name:DENALI VISION CLINIC
Entity Type:Organization
Organization Name:DENALI VISION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:BACH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-561-8120
Mailing Address - Street 1:3401 DENALI ST
Mailing Address - Street 2:STE 204
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4001
Mailing Address - Country:US
Mailing Address - Phone:907-561-8120
Mailing Address - Fax:907-562-1281
Practice Address - Street 1:3401 DENALI ST
Practice Address - Street 2:STE 204
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4001
Practice Address - Country:US
Practice Address - Phone:907-561-8120
Practice Address - Fax:907-562-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK67152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty