Provider Demographics
NPI:1306844535
Name:FINE, IRWIN HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:IRWIN
Middle Name:HOWARD
Last Name:FINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 OAK ST
Mailing Address - Street 2:STE 5
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7701
Mailing Address - Country:US
Mailing Address - Phone:541-687-2110
Mailing Address - Fax:541-484-3883
Practice Address - Street 1:1550 OAK ST
Practice Address - Street 2:STE 5
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7701
Practice Address - Country:US
Practice Address - Phone:541-687-2110
Practice Address - Fax:541-484-3883
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD07600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180012191OtherRAILROAD MEDICARE
180043383OtherRAILROAD MEDICARE
OR062083Medicaid
C94315Medicare UPIN
R111929Medicare PIN
OR062083Medicaid