Provider Demographics
NPI:1639247885
Name:THE EYE CLINIC PC
Entity Type:Organization
Organization Name:THE EYE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-297-4718
Mailing Address - Street 1:9155 SW BARNES RD STE 340
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6630
Mailing Address - Country:US
Mailing Address - Phone:503-297-4718
Mailing Address - Fax:503-292-4496
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:STE 430
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-297-4718
Practice Address - Fax:503-292-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR084145Medicaid
R0000WCGDRMedicare PIN
OR0642550001Medicare NSC