Provider Demographics
NPI:1578686002
Name:KENTANA INC
Entity Type:Organization
Organization Name:KENTANA INC
Other - Org Name:EYE TO EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY, KENTANA INC.
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRISCOE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-722-7737
Mailing Address - Street 1:22400 S SALAMO RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-8269
Mailing Address - Country:US
Mailing Address - Phone:503-722-7737
Mailing Address - Fax:503-722-4152
Practice Address - Street 1:22400 S SALAMO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-8269
Practice Address - Country:US
Practice Address - Phone:503-722-7737
Practice Address - Fax:503-722-4152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR113704Medicare PIN
OR4524900002Medicare NSC