1639369135 NPI number — CENTRAL POINT EYECARE, P.C.

Table of content: (NPI 1639369135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639369135 NPI number — CENTRAL POINT EYECARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL POINT EYECARE, 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:
1639369135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 E PINE ST
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
CENTRAL POINT
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97502-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-664-5535
Provider Business Mailing Address Fax Number:
541-664-7745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 E PINE ST
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
CENTRAL POINT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97502-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-664-5535
Provider Business Practice Location Address Fax Number:
541-664-7745
Provider Enumeration Date:
07/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
541-664-5535

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2302ATI , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 274748 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807295000 . This is a "BLUE CROSS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 410047151 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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