Provider Demographics
NPI:1083805774
Name:EYE CLINIC OF MILWAUKIE, P.C.
Entity Type:Organization
Organization Name:EYE CLINIC OF MILWAUKIE, P.C.
Other - Org Name:CHAMBERS AND FROLAND ODS P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-654-3212
Mailing Address - Street 1:2306 SE WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:503-654-3212
Mailing Address - Fax:503-652-2460
Practice Address - Street 1:2306 SE WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222
Practice Address - Country:US
Practice Address - Phone:503-654-3212
Practice Address - Fax:503-652-2460
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CLINIC OF MILWAUKIE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-07
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR 1228-ATI152W00000X
OROR-1228ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OROOOOWCJWWMedicare UPIN