Provider Demographics
NPI:1467727255
Name:OLIANA EYE INSTITUTE
Entity Type:Organization
Organization Name:OLIANA EYE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:VAUGHN
Authorized Official - Last Name:BRINKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-607-1711
Mailing Address - Street 1:77 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-1786
Mailing Address - Country:US
Mailing Address - Phone:541-607-1711
Mailing Address - Fax:541-607-1711
Practice Address - Street 1:77 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-1786
Practice Address - Country:US
Practice Address - Phone:541-607-1711
Practice Address - Fax:541-607-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18566207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH13011Medicare UPIN