Provider Demographics
NPI:1871827535
Name:EYE HEALTH NORTHWEST P.C.
Entity Type:Organization
Organization Name:EYE HEALTH NORTHWEST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-344-5101
Mailing Address - Street 1:11086 SE OAK ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6692
Mailing Address - Country:US
Mailing Address - Phone:503-557-2020
Mailing Address - Fax:503-344-5110
Practice Address - Street 1:1306 DIVISION ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1523
Practice Address - Country:US
Practice Address - Phone:503-656-4221
Practice Address - Fax:503-656-4249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE HEALTH NORTHWEST P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-29
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR085006Medicaid
OR0522570010Medicare NSC
OR085006Medicaid