Provider Demographics
NPI:1063635506
Name:DESCHUTES EYE CLINIC INC
Entity Type:Organization
Organization Name:DESCHUTES EYE CLINIC INC
Other - Org Name:EYE SURGERY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAUSTASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-548-7170
Mailing Address - Street 1:1775 SW UMATILLA AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7197
Mailing Address - Country:US
Mailing Address - Phone:541-548-7170
Mailing Address - Fax:541-548-3842
Practice Address - Street 1:1775 SW UMATILLA AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-7197
Practice Address - Country:US
Practice Address - Phone:541-548-7170
Practice Address - Fax:541-548-3842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR071581261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR138874101OtherBLUE CROSS PARTICIPATING
OR490003253OtherRR MEDICARE
OR180029258OtherUNITED HEALTHCARE RR
OR165450Medicaid
OR180029258OtherUNITED HEALTHCARE RR
ORR0000DBCBPMedicare PIN