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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

NPI # 1659400596
LBN Legal business name THE VILLIAGE STORE INC
Authorized official JAMES GRAVES - (PRESIDENT OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 03/05/2007
Last updated 08/22/2020 - About 6 years ago
Identifiers
AK License # 97
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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