Provider Demographics
NPI:1649379280
Name:SCHOU, KEVIN (BCO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:SCHOU
Suffix:
Gender:M
Credentials:BCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 MERCANTILE DR STE 208
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2591
Mailing Address - Country:US
Mailing Address - Phone:503-675-1320
Mailing Address - Fax:
Practice Address - Street 1:1800 VALLEY RIVER DR STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6720
Practice Address - Country:US
Practice Address - Phone:800-200-0908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR125096Medicaid
OR125096Medicaid