Provider Demographics
NPI:1821635293
Name:RENNARD EYECARE, LLC
Entity Type:Organization
Organization Name:RENNARD EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:RENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-317-6724
Mailing Address - Street 1:600 E NORTHERN LIGHTS BLVD STE 136B
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4162
Mailing Address - Country:US
Mailing Address - Phone:907-258-6333
Mailing Address - Fax:907-258-6968
Practice Address - Street 1:600 E NORTHERN LIGHTS BLVD STE 136B
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4162
Practice Address - Country:US
Practice Address - Phone:907-258-6333
Practice Address - Fax:907-258-6968
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENNARD EYECARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1023192Medicaid