Provider Demographics
NPI:1508149063
Name:MODERN EYEZ INC
Entity Type:Organization
Organization Name:MODERN EYEZ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-312-6464
Mailing Address - Street 1:18750 WILLAMETTE DR STE C
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1700
Mailing Address - Country:US
Mailing Address - Phone:503-697-8879
Mailing Address - Fax:
Practice Address - Street 1:18750 WILLAMETTE DR STE C
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-1700
Practice Address - Country:US
Practice Address - Phone:503-697-8879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3272ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty