Provider Demographics
NPI:1508037607
Name:DOUBLE VISION INC
Entity Type:Organization
Organization Name:DOUBLE VISION INC
Other - Org Name:HAPPY VALLEY VISION SOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:BERK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-698-2375
Mailing Address - Street 1:13180 SE 169TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-8727
Mailing Address - Country:US
Mailing Address - Phone:503-698-2375
Mailing Address - Fax:503-698-3398
Practice Address - Street 1:13180 SE 169TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086
Practice Address - Country:US
Practice Address - Phone:503-698-2375
Practice Address - Fax:503-698-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1749ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R0000WDBCWMedicare PIN