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Organization

PERSONETT FAMILY EYECARE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CHAD PERSONETT O.D. (OPTOMETRIST)
(907) 452-2131
Entity
Organization

Contact information

Practice address
1867 AIRPORT WAY, SUITE 150-A, FAIRBANKS, AK 99701-4054
(907) 452-2131
(907) 452-2131
Mailing address
1214 RIDGEPOINTE DR, FAIRBANKS, AK 99709-5737
(907) 452-2131
(907) 452-2131

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
AK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
K162115
MEDICARE PTAN
AK
05
VG0005
AK
Enumeration date
11/17/2008
Last updated
09/22/2016
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