Provider Demographics
NPI:1255859799
Name:MEDICAL CENTER EYE CLINIC LLC
Entity Type:Organization
Organization Name:MEDICAL CENTER EYE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:NIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-581-5287
Mailing Address - Street 1:655 MEDICAL CENTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2751
Mailing Address - Country:US
Mailing Address - Phone:503-581-5287
Mailing Address - Fax:503-588-6843
Practice Address - Street 1:655 MEDICAL CENTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2751
Practice Address - Country:US
Practice Address - Phone:503-581-5287
Practice Address - Fax:503-588-6843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty