Provider Demographics
NPI:1518252139
Name:COLUMBIA FAMILY VISION CARE LLC
Entity Type:Organization
Organization Name:COLUMBIA FAMILY VISION CARE LLC
Other - Org Name:GW CURNUTT & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-397-4911
Mailing Address - Street 1:2020 COLUMBIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-1737
Mailing Address - Country:US
Mailing Address - Phone:541-760-3448
Mailing Address - Fax:503-397-3986
Practice Address - Street 1:2020 COLUMBIA BLVD
Practice Address - Street 2:
Practice Address - City:ST HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-1737
Practice Address - Country:US
Practice Address - Phone:541-760-3448
Practice Address - Fax:503-397-3986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-11
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3367ATI152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500636929Medicaid
R160457Medicare PIN