Provider Demographics
NPI:1154452894
Name:POMEROY EYECARE, P.C.
Entity Type:Organization
Organization Name:POMEROY EYECARE, P.C.
Other - Org Name:JAMES P. RANDOLPH, O. D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-363-9011
Mailing Address - Street 1:1960 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5206
Mailing Address - Country:US
Mailing Address - Phone:503-363-9011
Mailing Address - Fax:503-362-6376
Practice Address - Street 1:1960 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5206
Practice Address - Country:US
Practice Address - Phone:503-363-9011
Practice Address - Fax:503-362-6376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1453ATI ACTIVE152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134049Medicare ID - Type UnspecifiedCORPORATION NUMBER