Provider Demographics
NPI:1003941873
Name:PENDLETON EYE CLINIC PC
Entity Type:Organization
Organization Name:PENDLETON EYE CLINIC PC
Other - Org Name:EAST OREGON EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BART
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-276-4752
Mailing Address - Street 1:1050 SOUTHGATE STE A
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3977
Mailing Address - Country:US
Mailing Address - Phone:541-276-4752
Mailing Address - Fax:541-278-2918
Practice Address - Street 1:1050 SOUTHGATE STE A
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3977
Practice Address - Country:US
Practice Address - Phone:541-276-4752
Practice Address - Fax:541-278-2918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR152W0000X152W00000X
OR207W0000X207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WCWBFMedicare ID - Type UnspecifiedBART A ADAMS, M.D.
ORE25055Medicare UPIN
OR0518660001Medicare NSC
ORU62889Medicare UPIN