Provider Demographics
NPI:1770761322
Name:DENALI FAMILY EYECARE, LLC
Entity type:Organization
Organization Name:DENALI FAMILY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:FOX-HOCKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-745-2070
Mailing Address - Street 1:1901 N HEMMER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-9690
Mailing Address - Country:US
Mailing Address - Phone:907-745-2070
Mailing Address - Fax:907-745-2079
Practice Address - Street 1:1901 N HEMMER RD STE 108
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9690
Practice Address - Country:US
Practice Address - Phone:907-745-2070
Practice Address - Fax:907-745-2079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2971 ATI152W00000X
152W00000X
OROR2971ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6677OtherEYEMED INSURANCE
ORR155045Medicare PIN