Provider Demographics
NPI:1003972225
Name:ON SIGHT OPTICAL, INC.
Entity Type:Organization
Organization Name:ON SIGHT OPTICAL, INC.
Other - Org Name:HENDRIX & MCGUIRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NIENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-228-2154
Mailing Address - Street 1:4542 NE MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3346
Mailing Address - Country:US
Mailing Address - Phone:503-228-2154
Mailing Address - Fax:503-228-4694
Practice Address - Street 1:4542 NE MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3346
Practice Address - Country:US
Practice Address - Phone:503-228-2154
Practice Address - Fax:503-228-4694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTIN CONFIDENTIALOtherCARE OREGON
OR278183Medicaid
OR278183Medicaid