Provider Demographics
NPI:1942383823
Name:ALASKA CENTER FOR THE BLIND AND VISUALLY IMPAIRED
Entity Type:Organization
Organization Name:ALASKA CENTER FOR THE BLIND AND VISUALLY IMPAIRED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYNARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:FALCONER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-248-7770
Mailing Address - Street 1:3903 TAFT DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-3069
Mailing Address - Country:US
Mailing Address - Phone:907-248-7770
Mailing Address - Fax:907-248-7517
Practice Address - Street 1:3903 TAFT DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-3069
Practice Address - Country:US
Practice Address - Phone:907-248-7770
Practice Address - Fax:907-248-7517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK47152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMS8817Medicaid
AKOD0047Medicaid
AKU06509Medicare UPIN
AK152984Medicare PIN
AKOD0047Medicaid