Individual
DR. MICHAEL J MAVENCAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
570 RIVERSTONE WAY, STE 3, FAIRBANKS, AK 99709
(907) 479-4700
(907) 457-5596
Mailing address
570 RIVERSTONE WAY, STE 3, FAIRBANKS, AK 99709
(907) 479-4700
(907) 457-5596
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
A240
AK
Other
Enumeration date
12/06/2006
Last updated
08/28/2012
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