Provider Demographics
NPI:1639243652
Name:SUNSET VISION CENTER
Entity Type:Organization
Organization Name:SUNSET VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-357-8454
Mailing Address - Street 1:333 S 1ST AVE
Mailing Address - Street 2:SUITE-A
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-3902
Mailing Address - Country:US
Mailing Address - Phone:503-357-8454
Mailing Address - Fax:503-357-8465
Practice Address - Street 1:333 S 1ST AVE
Practice Address - Street 2:SUITE-A
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-3902
Practice Address - Country:US
Practice Address - Phone:503-357-8454
Practice Address - Fax:503-357-8465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6483620001Medicare NSC
ORR147907Medicare PIN