Provider Demographics
NPI:1093397671
Name:A SIGHT FOR SPORT EYES
Entity Type:Organization
Organization Name:A SIGHT FOR SPORT EYES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:ABO
Authorized Official - Phone:503-699-4160
Mailing Address - Street 1:1553 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4636
Mailing Address - Country:US
Mailing Address - Phone:503-699-4160
Mailing Address - Fax:888-240-6551
Practice Address - Street 1:1553 11TH ST
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4636
Practice Address - Country:US
Practice Address - Phone:503-699-4160
Practice Address - Fax:888-240-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty