Provider Demographics
NPI:1497152573
Name:CASCADE OPTOMETRY,INC
Entity Type:Organization
Organization Name:CASCADE OPTOMETRY,INC
Other - Org Name:CASCADE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KITCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-378-0033
Mailing Address - Street 1:4141 NE STEPHENS ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1161
Mailing Address - Country:US
Mailing Address - Phone:541-378-0033
Mailing Address - Fax:
Practice Address - Street 1:4141 NE STEPHENS ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1161
Practice Address - Country:US
Practice Address - Phone:541-378-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3159 ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR155795OtherMEDICARE PTAN