Provider Demographics
NPI:1790757185
Name:DECALESTA, PAMELA LAMMERS (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LAMMERS
Last Name:DECALESTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 E 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3778
Mailing Address - Country:US
Mailing Address - Phone:541-343-3333
Mailing Address - Fax:
Practice Address - Street 1:2540 WILLAKENZIE RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4805
Practice Address - Country:US
Practice Address - Phone:541-484-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2672AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR112099Medicare UPIN
ORR112098Medicare PIN
ORU79237Medicare UPIN