Provider Demographics
NPI:1376903328
Name:ATLAS EYE GROUP LLC
Entity Type:Organization
Organization Name:ATLAS EYE GROUP LLC
Other - Org Name:MULTNOMAH VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-740-4942
Mailing Address - Street 1:2330 HERITAGE WAY SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-8600
Mailing Address - Country:US
Mailing Address - Phone:541-740-4942
Mailing Address - Fax:
Practice Address - Street 1:7826 SW CAPITOL HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2466
Practice Address - Country:US
Practice Address - Phone:541-740-4942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2674ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty