Provider Demographics
NPI:1275578775
Name:HILLSBORO EYE CLINIC, PC
Entity Type:Organization
Organization Name:HILLSBORO EYE CLINIC, PC
Other - Org Name:HILLSBORO OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-640-3708
Mailing Address - Street 1:512 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4137
Mailing Address - Country:US
Mailing Address - Phone:503-640-3708
Mailing Address - Fax:503-693-0441
Practice Address - Street 1:512 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4137
Practice Address - Country:US
Practice Address - Phone:503-640-3708
Practice Address - Fax:503-693-0441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR223099Medicaid
ORR0000WCJKJMedicare PIN
AKK0000WFBXKMedicare PIN
OR0306240003Medicare NSC
OR0306240001Medicare NSC