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Provider Information for 1922205061

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MAVENCAMP FAMILY EYECARE, INC

Organization Subpart: NO

Organization NPI: 1922205061

Calendar   Last Updated:  2014-01-02
  Certification Date: 

Details

Name Value
NPI 1922205061
Enumeration Date 2007-07-02
NPI Type 2- Organization
Status Active
Authorized Official Information Name: DR. MICHAEL MAVENCAMP O.D.
Title: PRESIDENT
Phone: 907-479-4700
Mailing Address 570 RIVERSTONE WAY SUITE 3
FAIRBANKS, AK 99709-2939
United States

Phone: 907-479-4700 | Fax: 907-457-5596
View Map External Link
Primary Practice Address 570 RIVERSTONE WAY SUITE 3
FAIRBANKS, AK 99709-2939
United States

Phone: 907-479-4700 | Fax: 907-457-5596
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 193400000X SINGLE SPECIALTY GROUP
152W00000X - Optometrist
AK A240