Provider Demographics
NPI:1851601561
Name:RIVER VIEW FAMILY EYECARE, LLC
Entity Type:Organization
Organization Name:RIVER VIEW FAMILY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BATEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:901-652-7312
Mailing Address - Street 1:27652 FERN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SWEET HOME
Mailing Address - State:OR
Mailing Address - Zip Code:97386-9529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:609 HICKORY ST NW
Practice Address - Street 2:STE. 160
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1763
Practice Address - Country:US
Practice Address - Phone:541-967-3097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3304ATI152W00000X
OR3346ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty