Provider Demographics
NPI:1619152485
Name:PATRICK AYRES, OD, PC
Entity Type:Organization
Organization Name:PATRICK AYRES, OD, PC
Other - Org Name:RIVERBEND EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:AYRES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-317-9747
Mailing Address - Street 1:143 SW SHEVLIN HIXON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3189
Mailing Address - Country:US
Mailing Address - Phone:541-317-9747
Mailing Address - Fax:541-317-1818
Practice Address - Street 1:143 SW SHEVLIN HIXON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3189
Practice Address - Country:US
Practice Address - Phone:541-317-9747
Practice Address - Fax:541-317-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-29
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3188AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278946Medicaid
ORR140350Medicare PIN
OR278946Medicaid