Provider Demographics
NPI:1629156187
Name:NORTHWEST EYE ASSOCIATES LLC
Entity Type:Organization
Organization Name:NORTHWEST EYE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-227-6568
Mailing Address - Street 1:2222 NW LOVEJOY ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3033
Mailing Address - Country:US
Mailing Address - Phone:503-227-6568
Mailing Address - Fax:503-227-3919
Practice Address - Street 1:2222 NW LOVEJOY ST
Practice Address - Street 2:SUITE 504
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3033
Practice Address - Country:US
Practice Address - Phone:503-227-6568
Practice Address - Fax:503-227-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR680887207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR133379Medicare PIN