Provider Demographics
NPI:1891985453
Name:CHRISTOPHER CARMIENCKE OD
Entity Type:Organization
Organization Name:CHRISTOPHER CARMIENCKE OD
Other - Org Name:INTEGRATED EYECARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMIENCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-382-5701
Mailing Address - Street 1:452 NE GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4608
Mailing Address - Country:US
Mailing Address - Phone:541-382-5701
Mailing Address - Fax:541-382-5702
Practice Address - Street 1:452 NE GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4608
Practice Address - Country:US
Practice Address - Phone:541-382-5701
Practice Address - Fax:541-382-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR1221AT152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR03256-5Medicaid
OR109031Medicare PIN
OR03256-5Medicaid
OR1043940001Medicare NSC