Organization
INTERIOR EYE CENTER, LLC
Active
Organization
INTERIOR EYE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY FULLER MD (OWNER)
(907) 479-2020
Entity
Organization
Contact information
Practice address
1405 KELLUM ST STE 300, FAIRBANKS, AK 99701-4189
(907) 479-2020
Mailing address
1405 KELLUM ST STE 300, FAIRBANKS, AK 99701-4189
(907) 370-3966
(907) 479-2021
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
156FX1800X
Optician
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2161194
STATE OF ALASKA BUSINESS LICENSE
AK
Enumeration date
05/03/2022
Last updated
07/22/2022
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