Provider Demographics
NPI:1629308010
Name:CEA ACQUISITION LLC
Entity Type:Organization
Organization Name:CEA ACQUISITION LLC
Other - Org Name:CASCADE EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLO MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:F.
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-652-0600
Mailing Address - Street 1:10001 SE SUNNYSIDE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5746
Mailing Address - Country:US
Mailing Address - Phone:503-562-0600
Mailing Address - Fax:503-652-0601
Practice Address - Street 1:10001 SE SUNNYSIDE RD
Practice Address - Street 2:STE 100
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5746
Practice Address - Country:US
Practice Address - Phone:503-562-0600
Practice Address - Fax:503-652-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1629188982OtherINDIVIDUAL NPI
OR131500Medicare PIN
OR6424770001Medicare NSC