Provider Demographics
NPI:1891282539
Name:NORTH POLE EYECARE LLC
Entity Type:Organization
Organization Name:NORTH POLE EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACQUISTAPACE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-978-2734
Mailing Address - Street 1:PO BOX 55897
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-0897
Mailing Address - Country:US
Mailing Address - Phone:907-385-3937
Mailing Address - Fax:
Practice Address - Street 1:145 S SANTA CLAUS LN
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-7754
Practice Address - Country:US
Practice Address - Phone:907-385-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKOPTT222152W00000X
AKDOPD259156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty