Provider Demographics
NPI:1427030881
Name:EYE HEALTH EASTSIDE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:EYE HEALTH EASTSIDE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-558-7372
Mailing Address - Street 1:11086 SE OAK ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6692
Mailing Address - Country:US
Mailing Address - Phone:503-557-2020
Mailing Address - Fax:503-344-5110
Practice Address - Street 1:12050 SE STEVENS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-7667
Practice Address - Country:US
Practice Address - Phone:971-206-6100
Practice Address - Fax:971-206-6103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5266730001Medicare NSC