Provider Demographics
NPI:1770109738
Name:RIDGEWAY, LEVI (OD)
Entity type:Individual
Prefix:DR
First Name:LEVI
Middle Name:
Last Name:RIDGEWAY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E DIMOND BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2029
Mailing Address - Country:US
Mailing Address - Phone:907-349-6932
Mailing Address - Fax:907-349-6347
Practice Address - Street 1:1000 E DIMOND BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2029
Practice Address - Country:US
Practice Address - Phone:907-349-6932
Practice Address - Fax:907-349-6347
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2734152W00000X
AK222789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist