Provider Demographics
NPI:1912389511
Name:CENTRAL OREGON EYECARE, PC
Entity Type:Organization
Organization Name:CENTRAL OREGON EYECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELLISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FELLINES-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-548-2488
Mailing Address - Street 1:1000 SW INDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-3024
Mailing Address - Country:US
Mailing Address - Phone:541-548-2488
Mailing Address - Fax:541-548-5334
Practice Address - Street 1:2155 NW SHEVLIN PARK RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701
Practice Address - Country:US
Practice Address - Phone:541-548-2488
Practice Address - Fax:541-548-5334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty