Provider Demographics
NPI:1598001844
Name:EAGLE EYE VISION CARE LLC
Entity Type:Organization
Organization Name:EAGLE EYE VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEIRSTEN
Authorized Official - Middle Name:DANEE
Authorized Official - Last Name:EAGLES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-385-8361
Mailing Address - Street 1:4048 RIVER RD N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5501
Mailing Address - Country:US
Mailing Address - Phone:503-385-8361
Mailing Address - Fax:503-385-8364
Practice Address - Street 1:4048 RIVER ROAD NORTH
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303
Practice Address - Country:US
Practice Address - Phone:503-385-8361
Practice Address - Fax:503-385-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3288ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty