Provider Demographics
NPI:1568648731
Name:PRECISION EYECARE P.C.
Entity Type:Organization
Organization Name:PRECISION EYECARE P.C.
Other - Org Name:PAULSON EYECARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-469-7775
Mailing Address - Street 1:586 5TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-9720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:586 5TH ST STE 300
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9720
Practice Address - Country:US
Practice Address - Phone:541-469-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1359AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027976Medicaid
OR236091Medicaid
ORDP1564Medicare UPIN
ORT67994Medicare UPIN
OR027976Medicaid
OR6193570001Medicare NSC