Provider Demographics
NPI:1073715157
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:
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MBA, FAAO
Authorized Official - Phone:541-548-2488
Mailing Address - Street 1:1000 SW INDIAN AVE
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 1:1000 SW INDIAN AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756
Practice Address - Country:US
Practice Address - Phone:541-548-2488
Practice Address - Fax:541-548-5334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2823ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR230762Medicaid
ORU85325Medicaid
ORR117492Medicare PIN
ORR117492Medicare UPIN
ORU85325Medicare UPIN
OR230762Medicaid