Individual
DEWAYNE HALVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3744 LAKE OTIS PKWY, ANCHORAGE, AK 99508-5208
(907) 561-5118
Mailing address
3744 LAKE OTIS PKWY, ANCHORAGE, AK 99508-5208
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
061
AK
152W00000X
Optometrist
4352
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OP0061
—
AK
Enumeration date
03/31/2007
Last updated
07/09/2007
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