Provider Demographics
NPI:1689189151
Name:PERSONALEYES, LLC
Entity Type:Organization
Organization Name:PERSONALEYES, LLC
Other - Org Name:WILLOW CREEK EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MBA, FAAO
Authorized Official - Phone:541-548-2488
Mailing Address - Street 1:1000 SW INDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-3039
Mailing Address - Country:US
Mailing Address - Phone:541-548-2488
Mailing Address - Fax:541-548-5334
Practice Address - Street 1:14740 NW CORNELL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5496
Practice Address - Country:US
Practice Address - Phone:503-645-8002
Practice Address - Fax:503-645-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2823ATI261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty