Provider Demographics
NPI:1134299241
Name:NORTHWEST EYE CENTER, PC
Entity Type:Organization
Organization Name:NORTHWEST EYE CENTER, PC
Other - Org Name:OPTICAL WESTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON-MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-672-2020
Mailing Address - Street 1:2435 NW KLINE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1690
Mailing Address - Country:US
Mailing Address - Phone:541-672-2020
Mailing Address - Fax:
Practice Address - Street 1:2435 NW KLINE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1690
Practice Address - Country:US
Practice Address - Phone:541-672-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR4117460001Medicare NSC