Organization
EAGLE RIVER VISION CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JAY FLECKENSTEIN OD (PRESIDENT)
(907) 694-2511
Entity
Organization
Contact information
Practice address
16331 HERITAGE PL, SUITE 104, EAGLE RIVER, AK 99577-7714
(907) 694-2511
(907) 694-3900
Mailing address
16331 HERITAGE PL, SUITE 104, EAGLE RIVER, AK 99577-7714
(907) 694-2511
(907) 694-3900
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
310247
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30000001SWGYEAS
CMS EHR CERTIFICATAION ID
—
Enumeration date
06/07/2006
Last updated
02/07/2013
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