Organization
DJ KOSTERMAN OD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN J KOSTERMAN OD (SOLE PROPRIETOR)
(907) 696-3031
Entity
Organization
Contact information
Practice address
11401 OLD GLENN HWY STE 106B, EAGLE RIVER, AK 99577-7747
(907) 696-8733
(907) 696-8735
Mailing address
11401 OLD GLENN HWY STE 106B, EAGLE RIVER, AK 99577-7747
(907) 696-8733
(907) 696-8735
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
161
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OD11612
—
AK
Enumeration date
11/27/2007
Last updated
09/23/2015
Update your record
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