1063521060 NPI number — OREGON EYE SPECIALISTS, PC

Table of content: (NPI 1063521060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063521060 NPI number — OREGON EYE SPECIALISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OREGON EYE SPECIALISTS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE SIGHT SHOP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063521060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6420 S MACADAM AVE STE 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97239-3517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-244-8601
Provider Business Mailing Address Fax Number:
503-244-3013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5050 NE HOYT ST
Provider Second Line Business Practice Location Address:
STE 445
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97213-2991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-231-7496
Provider Business Practice Location Address Fax Number:
503-231-1785
Provider Enumeration Date:
08/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GATTEY
Authorized Official First Name:
DEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OPHTHALMOLOGIST, COMPANY PRESIDENT
Authorized Official Telephone Number:
503-244-8601

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)