Provider Demographics
NPI:1770908519
Name:FAR NORTH EYE CARE, LLC
Entity type:Organization
Organization Name:FAR NORTH EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEDIGO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-891-7191
Mailing Address - Street 1:3705 ARCTIC BLVD
Mailing Address - Street 2:#2244
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5774
Mailing Address - Country:US
Mailing Address - Phone:907-891-7191
Mailing Address - Fax:425-328-1254
Practice Address - Street 1:1515 E TUDOR RD STE 5
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1036
Practice Address - Country:US
Practice Address - Phone:907-770-7747
Practice Address - Fax:425-328-1254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK277152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK165697Medicare PIN