Provider Demographics
NPI:1629186788
Name:OREGON EYE SPECIALISTS, PC
Entity Type:Organization
Organization Name:OREGON EYE SPECIALISTS, PC
Other - Org Name:THE SIGHT SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPHTHALMOLOGIST, COMPANY PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GATTEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-244-8601
Mailing Address - Street 1:6420 S MACADAM AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3517
Mailing Address - Country:US
Mailing Address - Phone:503-244-8601
Mailing Address - Fax:503-244-3013
Practice Address - Street 1:9 MONROE PKWY STE 160
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8863
Practice Address - Country:US
Practice Address - Phone:503-636-2551
Practice Address - Fax:503-699-8772
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OREGON EYE SPECIALISTS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-29
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WCQKSMedicare PIN
OR0769880005Medicare NSC