Provider Demographics
NPI:1528396850
Name:OREGON HEALTH SCIENCES UNIVERSITY DEPARTMENT OF OPHTHALMOLOGY
Entity Type:Organization
Organization Name:OREGON HEALTH SCIENCES UNIVERSITY DEPARTMENT OF OPHTHALMOLOGY
Other - Org Name:OHSU CASEY EYE INSTITUTE AT CHH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, UNIVERSITY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:503-494-8252
Mailing Address - Street 1:3375 SW TERWILLIGER BLVD
Mailing Address - Street 2:ATTN: E. COTTLER - CEI-CHH
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4146
Mailing Address - Country:US
Mailing Address - Phone:503-494-7890
Mailing Address - Fax:
Practice Address - Street 1:3303 SW BOND AVE
Practice Address - Street 2:SUITE 1101 - OPTICAL SHOP
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3884840003Medicare NSC