Basic Information
| Provider Information | |||||||||
| NPI: | 1538278684 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OREGON EYE SPECIALISTS, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE SIGHT SHOP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6420 S MACADAM AVE STE 160 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972393517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032448601 | ||||||||
| FaxNumber: | 5032443013 | ||||||||
| Practice Location | |||||||||
| Address1: | 18345 SW ALEXANDER ST | ||||||||
| Address2: | STE D | ||||||||
| City: | ALOHA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970063960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036490474 | ||||||||
| FaxNumber: | 5033568074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/01/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | GATTEY | ||||||||
| AuthorizedOfficialFirstName: | DEVIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OPHTHALMOLOGIST, COMPANY PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5032448601 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OREGON EYE SPECIALISTS, PC | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.