Provider Demographics
NPI:1689898694
Name:ALBANY EYECARE CENTER PC
Entity Type:Organization
Organization Name:ALBANY EYECARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-926-6077
Mailing Address - Street 1:2330 HERITAGE WAY SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-8600
Mailing Address - Country:US
Mailing Address - Phone:541-926-6077
Mailing Address - Fax:541-926-0605
Practice Address - Street 1:2330 HERITAGE WAY SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-8600
Practice Address - Country:US
Practice Address - Phone:541-926-6077
Practice Address - Fax:541-926-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182709Medicaid
DA2821OtherRAILROAD MEDICARE
009446000OtherREGENCE BCBS
ORU41603Medicare UPIN
R0000WCKKFMedicare PIN
009446000OtherREGENCE BCBS
ORV06156Medicare UPIN
DA2821OtherRAILROAD MEDICARE