Provider Demographics
NPI:1275308835
Name:MOBILITYCARES OREGON LLC
Entity Type:Organization
Organization Name:MOBILITYCARES OREGON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-995-1122
Mailing Address - Street 1:13243 LEWIS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-1029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13243 LEWIS RANCH RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-1029
Practice Address - Country:US
Practice Address - Phone:208-995-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty