Provider Demographics
NPI:1568780955
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 ASTORIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, OHSU
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-494-8252
Mailing Address - Street 1:1400 SW 5TH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5537
Mailing Address - Country:US
Mailing Address - Phone:503-494-8417
Mailing Address - Fax:503-494-4455
Practice Address - Street 1:2055 EXCHANGE ST
Practice Address - Street 2:SUITE #230
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3419
Practice Address - Country:US
Practice Address - Phone:503-338-3803
Practice Address - Fax:503-338-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3884840005Medicare NSC