Provider Demographics
NPI:1023199734
Name:OREGON EYE CONSULTANTS LLC
Entity Type:Organization
Organization Name:OREGON EYE CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-687-1927
Mailing Address - Street 1:1550 OAK STREET
Mailing Address - Street 2:SUITE #7
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-687-1927
Mailing Address - Fax:541-683-8779
Practice Address - Street 1:1550 OAK STREET
Practice Address - Street 2:SUITE #7
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-687-1927
Practice Address - Fax:541-683-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288509Medicaid
CG6842OtherMEDICARE, RR
CG6841OtherMEDICARE, RR
CG6841OtherMEDICARE, RR
R106633Medicare ID - Type Unspecified