Individual
DR. CHAD D PERSONETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1867 AIRPORT WAY, SUITE 150-A, FAIRBANKS, AK 99701-4007
(907) 452-2131
(907) 452-2618
Mailing address
1867 AIRPORT WAY, SUITE 150-A, FAIRBANKS, AK 99701-4007
(907) 452-2131
(907) 452-2618
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
AA 193
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101205500
DEPT OF LABOR
AK
01
—
7731257
AETNA
AK
01
—
N2402
BLUE CROSS BLUE SHIELD
AK
05
—
OD3575
—
AK
Enumeration date
12/11/2006
Last updated
07/22/2009
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