Provider Demographics
NPI:1821049073
Name:CASCADE EYE CENTERLLC
Entity Type:Organization
Organization Name:CASCADE EYE CENTERLLC
Other - Org Name:CASCADE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNERPARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-296-1101
Mailing Address - Street 1:301 CHERRY HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3586
Mailing Address - Country:US
Mailing Address - Phone:541-296-1101
Mailing Address - Fax:541-298-1538
Practice Address - Street 1:301 CHERRY HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3586
Practice Address - Country:US
Practice Address - Phone:541-296-1101
Practice Address - Fax:541-298-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO22937207W00000X
WAOP00002068207W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287610Medicaid
ORR108870Medicare PIN
OR1301400003Medicare NSC
OR287610Medicaid