1174857833 NPI number — EYE HEALTH NORTHWEST P.C.

Table of content: (NPI 1174857833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174857833 NPI number — EYE HEALTH NORTHWEST P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE HEALTH NORTHWEST P.C.
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:
Provider Other Organization Name Type Code:
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:
1174857833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22009
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:
97269-2009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-558-7372
Provider Business Mailing Address Fax Number:
503-344-5140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6701 NE GLISAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97213-5553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-255-2291
Provider Business Practice Location Address Fax Number:
503-234-2324
Provider Enumeration Date:
09/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
503-558-7372

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 085006 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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