Provider Demographics
NPI:1821185588
Name:HILLSBORO EYE CLINIC,PC
Entity Type:Organization
Organization Name:HILLSBORO EYE CLINIC,PC
Other - Org Name:HILLSBORO OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-640-3708
Mailing Address - Street 1:512 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4137
Mailing Address - Country:US
Mailing Address - Phone:503-640-3708
Mailing Address - Fax:503-693-0441
Practice Address - Street 1:512 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4137
Practice Address - Country:US
Practice Address - Phone:503-640-3708
Practice Address - Fax:503-693-0441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HILLSBORO EYE CLINIC, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR223099Medicaid
OR0306240001Medicare NSC
OR0306240001Medicare PIN