| Organization Name: | CLASSIC EYEWARE |
| NPI Number: | 1013085539 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ELIZABETH MCDANELD (OPTICIAN) |
| Mailing Address: | 935 E Westpoint Dr Ste 207 Wasilla |
| State: | AK US |
| Postal Code: | 99654 |
| Phone Number: | 9073769173 |
| Fax Number: | 9073768180 |
| NPI Enumeration Date: | 12/01/2006 |
| NPI Last Update Date: | 06/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | 172 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |