Provider Demographics
NPI:1063681617
Name:OREGON EYE SPECIALISTS PC
Entity Type:Organization
Organization Name:OREGON EYE SPECIALISTS PC
Other - Org Name:THE SIGHT SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPHTHALMOLOGIST/COMPANY PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GATTEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-244-8601
Mailing Address - Street 1:6420 S MACADAM AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3517
Mailing Address - Country:US
Mailing Address - Phone:503-244-1214
Mailing Address - Fax:503-244-3013
Practice Address - Street 1:5050 NE HOYT ST STE 445
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2984
Practice Address - Country:US
Practice Address - Phone:503-231-0166
Practice Address - Fax:503-231-2720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OREGON EYE SPECIALISTS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-28
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000WCTBYMedicare PIN