Basic Information
| Provider Information | |||||||||
| NPI: | 1851400808 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OREGON EYE SPECIALISTS, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SIGHT SHOP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6420 SW MACADAM AVE | ||||||||
| Address2: | SUITE 216 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972393507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032448601 | ||||||||
| FaxNumber: | 5032443013 | ||||||||
| Practice Location | |||||||||
| Address1: | 1130 NW 22ND AVE | ||||||||
| Address2: | SUITE 630 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972102900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032288469 | ||||||||
| FaxNumber: | 5032410587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 05/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | THURSTON | ||||||||
| AuthorizedOfficialFirstName: | TERI | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5039355564 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OREGON EYE SPECIALISTS, PC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.