Provider Demographics
NPI:1033640446
Name:OGATA EYECARE PC
Entity Type:Organization
Organization Name:OGATA EYECARE PC
Other - Org Name:DR. DALE OGATA & ASSOCIATES PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:E
Authorized Official - Last Name:OGATA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-598-7428
Mailing Address - Street 1:9300 SW WASHINGTON SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4428
Mailing Address - Country:US
Mailing Address - Phone:503-598-7428
Mailing Address - Fax:503-624-0959
Practice Address - Street 1:9300 SW WASHINGTON SQUARE RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4428
Practice Address - Country:US
Practice Address - Phone:503-598-7428
Practice Address - Fax:503-624-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1716ATI152W00000X
OR2564ATI152W00000X
OR3599ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1114092269Medicare UPIN
OR1720331549Medicare UPIN
OR1427184746Medicare UPIN