Provider Demographics
NPI:1245331438
Name:KENAI VISION CENTER
Entity type:Organization
Organization Name:KENAI VISION CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWARNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-283-7575
Mailing Address - Street 1:110 S WILLOW ST STE 108
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7798
Mailing Address - Country:US
Mailing Address - Phone:907-283-7575
Mailing Address - Fax:907-283-6156
Practice Address - Street 1:110 S WILLOW ST STE 108
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7798
Practice Address - Country:US
Practice Address - Phone:907-283-7575
Practice Address - Fax:907-283-6156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK63959152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1154318889OtherR O'CONNELL NPI
AK1568459295OtherD SWARNER NPI
AKOP0081Medicaid
AKVG3959Medicaid
AKOP0072Medicaid
AKK0000WCQHDMedicare ID - Type UnspecifiedKENAI VISION CENTER
AKK00WCQHWBMedicare ID - Type UnspecifiedR O'CONNELL
AKT67069Medicare UPIN
AKK00WCQHWAMedicare ID - Type UnspecifiedD. SWARNER
AKOP0081Medicaid