Provider Demographics
NPI:1619086550
Name:OREGON EYE SPECIALISTS
Entity Type:Organization
Organization Name:OREGON EYE SPECIALISTS
Other - Org Name:SIGHT SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:THURSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-935-5564
Mailing Address - Street 1:6420 SW MACADAM AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3507
Mailing Address - Country:US
Mailing Address - Phone:503-244-8601
Mailing Address - Fax:503-244-3013
Practice Address - Street 1:1380 E POWELL BLVD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8004
Practice Address - Country:US
Practice Address - Phone:503-492-4128
Practice Address - Fax:503-492-4107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OREGON EYE SPECIALISTS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WCTBYMedicare PIN
0769880013Medicare NSC