Provider Demographics
NPI:1083246292
Name:GATTI VISION LLC
Entity Type:Organization
Organization Name:GATTI VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-371-3927
Mailing Address - Street 1:15405 SW 116TH AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97224-4101
Mailing Address - Country:US
Mailing Address - Phone:971-371-3927
Mailing Address - Fax:888-411-0427
Practice Address - Street 1:15405 SW 116TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:OR
Practice Address - Zip Code:97224-4101
Practice Address - Country:US
Practice Address - Phone:971-371-3927
Practice Address - Fax:888-411-0427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty