Provider Demographics
NPI:1508970898
Name:COMPLETE VISION CENTER, P.C.
Entity Type:Organization
Organization Name:COMPLETE VISION CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-747-0616
Mailing Address - Street 1:1717 CENTENNIAL BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3378
Mailing Address - Country:US
Mailing Address - Phone:541-747-0616
Mailing Address - Fax:541-747-0617
Practice Address - Street 1:1717 CENTENNIAL BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3378
Practice Address - Country:US
Practice Address - Phone:541-747-0616
Practice Address - Fax:541-747-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2697T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3011OtherLIPA
OR208294Medicaid
ORU71633Medicare UPIN
OR3011OtherLIPA
OR130572Medicare PIN