Provider Demographics
NPI:1407841406
Name:DRS MAUCK & PERKINS OPT PC
Entity Type:Organization
Organization Name:DRS MAUCK & PERKINS OPT PC
Other - Org Name:MID COLUMBIA VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MAUCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-296-2911
Mailing Address - Street 1:PO BOX 883
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-0883
Mailing Address - Country:US
Mailing Address - Phone:541-296-2911
Mailing Address - Fax:541-296-2224
Practice Address - Street 1:415 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2215
Practice Address - Country:US
Practice Address - Phone:541-296-2911
Practice Address - Fax:541-296-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000WCJSGMedicare ID - Type Unspecified
R0000WCJSGMedicare PIN
OR0282950001Medicare NSC