Provider Demographics
NPI:1811598535
Name:LAST FRONTIER EYE CARE
Entity Type:Organization
Organization Name:LAST FRONTIER EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ONEIL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-443-3553
Mailing Address - Street 1:PO BOX 1049
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762-1049
Mailing Address - Country:US
Mailing Address - Phone:907-443-3553
Mailing Address - Fax:844-901-4313
Practice Address - Street 1:309 BERING ST
Practice Address - Street 2:
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762
Practice Address - Country:US
Practice Address - Phone:907-443-3553
Practice Address - Fax:844-901-4313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1070705Medicaid