Provider Demographics
NPI:1083994867
Name:CENTER FOR OCULAR PROSTHETICS LLC
Entity Type:Organization
Organization Name:CENTER FOR OCULAR PROSTHETICS LLC
Other - Org Name:CHRISTINA LEITZEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCULARIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:LEITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:BS, BCO, BADO
Authorized Official - Phone:503-229-8490
Mailing Address - Street 1:2456 NW NORTHRUP ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3253
Mailing Address - Country:US
Mailing Address - Phone:503-229-8490
Mailing Address - Fax:503-224-0740
Practice Address - Street 1:2456 NW NORTHRUP ST STE 1A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3253
Practice Address - Country:US
Practice Address - Phone:503-229-8490
Practice Address - Fax:503-224-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1700X, 332BC3200X
OR51680289332BC3200X
OR516802-89335E00000X
VA149156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR01621900001OtherREGENCE BCBS DME SUPPLIER
OR01621900001OtherREGENCE BCBS
OR500647964Medicaid
OR01758092-1OtherOREGON BUSINESS IDENTIFICATION NUMBER
OR01621900001OtherREGENCE BCBS