Provider Demographics
NPI:1902936412
Name:BRINKERHOFF, DENNIS RAYMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RAYMOND
Last Name:BRINKERHOFF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W DIMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1903
Mailing Address - Country:US
Mailing Address - Phone:907-267-7102
Mailing Address - Fax:907-349-7039
Practice Address - Street 1:330 W DIMOND BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1903
Practice Address - Country:US
Practice Address - Phone:907-267-7102
Practice Address - Fax:907-349-7039
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK106152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOPO1061Medicaid
KOOOOPHGLRMedicare ID - Type Unspecified
AKOPO1061Medicaid