1487721023 NPI number — OREGON EYE SPECIALISTS PC

Table of content: (NPI 1487721023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487721023 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:
1487721023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2020
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:
6420 S MACADAM AVE STE 160
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:
97239-3517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-244-8601
Provider Business Practice Location Address Fax Number:
503-244-3013
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 07894-4 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14958-3 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22634-4 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: CS5592 . This is a "RR MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02262-6 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06527-1 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22633-5 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26075-2 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02557-2 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04877-7 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23334-9 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH568 . This is a "RR MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27152-8 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27665-8 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 28849-0 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA3276 . This is a "RR MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21536-8 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22935-3 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06008-7 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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