Provider Demographics
NPI:1235260209
Name:CORVALLIS VISION CNETER P.C.
Entity Type:Organization
Organization Name:CORVALLIS VISION CNETER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-757-1120
Mailing Address - Street 1:130 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4714
Mailing Address - Country:US
Mailing Address - Phone:541-757-1120
Mailing Address - Fax:
Practice Address - Street 1:130 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4714
Practice Address - Country:US
Practice Address - Phone:541-757-1120
Practice Address - Fax:541-757-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1404AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU23401Medicare UPIN