1528050523 NPI number — DESCHUTES EYE CLINIC PC

Table of content: (NPI 1528050523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528050523 NPI number — DESCHUTES EYE CLINIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESCHUTES EYE CLINIC 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 EYE SURGERY INSTITUTE
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:
1528050523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
813 SW HIGHLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDMOND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97756-3123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-548-7170
Provider Business Mailing Address Fax Number:
541-548-3842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
813 SW HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97756-3123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-548-7170
Provider Business Practice Location Address Fax Number:
541-548-3842
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TRAUSTASON
Authorized Official First Name:
OLI
Authorized Official Middle Name:
I
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
541-548-7170

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: 053857000 . This is a "REGENCE BCBS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: CJ8770 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 38080A . This is a "CLEAR CHOICE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com