Provider Demographics
NPI:1619127271
Name:GREG SCHOBER PC
Entity Type:Organization
Organization Name:GREG SCHOBER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCOBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-222-2990
Mailing Address - Street 1:5901 SW MACADAM AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5901 SW MACADAM AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3620
Practice Address - Country:US
Practice Address - Phone:503-222-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1457 ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR144040Medicare PIN