Basic Information
| Provider Information | |||||||||
| NPI: | 1811438286 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLAS EYE GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7826 SW CAPITOL HWY | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972192466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032447788 | ||||||||
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| Practice Location | |||||||||
| Address1: | 226 E HISTORIC COLUMBIA RIVER HWY | ||||||||
| Address2: | |||||||||
| City: | TROUTDALE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970602069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034923897 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2017 | ||||||||
| LastUpdateDate: | 01/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | HALE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | ROSS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5417404942 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2674ATI | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.