Provider Demographics
NPI:1053307413
Name:WILLAMETTE VISION CENTER INC
Entity Type:Organization
Organization Name:WILLAMETTE VISION CENTER INC
Other - Org Name:FAMILY FOCUS VISION SOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:VORPAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-585-6700
Mailing Address - Street 1:3400 STATE ST
Mailing Address - Street 2:#G-770
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-5861
Mailing Address - Country:US
Mailing Address - Phone:503-585-6700
Mailing Address - Fax:503-585-3315
Practice Address - Street 1:3400 STATE ST
Practice Address - Street 2:#G-770
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5861
Practice Address - Country:US
Practice Address - Phone:503-585-6700
Practice Address - Fax:503-585-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1666AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty