Provider Demographics
NPI:1003930132
Name:EYEDENTITY VISION CENTER P.C.
Entity Type:Organization
Organization Name:EYEDENTITY VISION CENTER P.C.
Other - Org Name:STEVEN J. CLOUSE, OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-238-1139
Mailing Address - Street 1:2609 SE CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1240
Mailing Address - Country:US
Mailing Address - Phone:503-238-1139
Mailing Address - Fax:503-235-6574
Practice Address - Street 1:2609 SE CLINTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1240
Practice Address - Country:US
Practice Address - Phone:503-238-1139
Practice Address - Fax:503-235-6574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2408T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1285640714OtherDR. CLOUSE'S NPI
OR1285640714OtherDR. CLOUSE'S NPI