Provider Demographics
NPI:1407112956
Name:BEAVERTON EYE HEALTH
Entity Type:Organization
Organization Name:BEAVERTON EYE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADINA
Authorized Official - Middle Name:NELA
Authorized Official - Last Name:ZAPODEANU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-625-2727
Mailing Address - Street 1:20407 SW BORCHERS DR
Mailing Address - Street 2:STE 202
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8988
Mailing Address - Country:US
Mailing Address - Phone:503-625-2727
Mailing Address - Fax:503-625-2727
Practice Address - Street 1:12345 SW HORIZON BLVD
Practice Address - Street 2:STE 49
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005
Practice Address - Country:US
Practice Address - Phone:503-350-2727
Practice Address - Fax:503-625-2727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHERWOOD FAMILY EYE HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3152ATI261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1659307932OtherINDIVIDUAL NPI FOR DR. ADINA NELA ZAPODEANU
OR1013045152OtherGROUP NPI FOR SHERWOOD FAMILY EYE HEALTH
OR240246Medicaid
OR241823Medicaid
ORR136829Medicare UPIN
ORR136828Medicare UPIN