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Contact Information

THE VILLIAGE STORE INC
3455 REWAK DR
SUITE 102
FAIRBANKS, AK99709
 Phone: 907-474-8695
 Fax: 907-474-8727
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for THE VILLIAGE STORE INC · (Female)

NPI # 1659400596
Status Active
Credentials
Entity Individual
Enumeration date 03/05/2007
Last updated 08/22/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers
  • AK License # 97
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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