Organization Name: | EAGLE RIVER VISION CLINIC INC |
NPI Number: | 1558301945 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERT JAY FLECKENSTEIN (PRESIDENT) |
Mailing Address: | 16331 Heritage Pl Suite 104 Eagle River |
State: | AK US |
Postal Code: | 995777714 |
Phone Number: | 9076942511 |
Fax Number: | 9076943900 |
NPI Enumeration Date: | 06/07/2006 |
NPI Last Update Date: | 02/07/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 310247 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AK |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |