Provider Demographics
NPI:1609268051
Name:BERNARD P CONWAY OD PC
Entity Type:Organization
Organization Name:BERNARD P CONWAY OD PC
Other - Org Name:SPECS 20/20
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-330-6478
Mailing Address - Street 1:700 NW 118TH AVE
Mailing Address - Street 2:NO. 103
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5925
Mailing Address - Country:US
Mailing Address - Phone:503-747-0265
Mailing Address - Fax:
Practice Address - Street 1:11805 NW CEDAR FALLS DR
Practice Address - Street 2:SUITE 105
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-2774
Practice Address - Country:US
Practice Address - Phone:503-747-0265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty