Provider Demographics
NPI:1053684597
Name:CENTRAL OREGON EYECARE, PC
Entity Type:Organization
Organization Name:CENTRAL OREGON EYECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-548-2488
Mailing Address - Street 1:1000 SW INDIAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756
Mailing Address - Country:US
Mailing Address - Phone:541-548-2488
Mailing Address - Fax:541-548-5334
Practice Address - Street 1:625 N ARROWLEAF TRAIL
Practice Address - Street 2:STE 103
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759
Practice Address - Country:US
Practice Address - Phone:541-549-2105
Practice Address - Fax:541-549-2106
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL OREGON EYECARE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-14
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2823ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty