Provider Demographics
NPI:1952630204
Name:OREGON HEALTH SCIENCES UNIVERSITY DEPARTMENT OF OPHTHALMOLOGY
Entity Type:Organization
Organization Name:OREGON HEALTH SCIENCES UNIVERSITY DEPARTMENT OF OPHTHALMOLOGY
Other - Org Name:OHSU LOWER COLUMBIA EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, UNIVERSITY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:503-494-8033
Mailing Address - Street 1:3375 SW TERWILLIGER BLVD
Mailing Address - Street 2:MAIL CODE: CEI -- ATTN E. COTTLE -- LONGVIEW
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4146
Mailing Address - Country:US
Mailing Address - Phone:503-494-8766
Mailing Address - Fax:
Practice Address - Street 1:600 TRIANGLE CENTER
Practice Address - Street 2:SUITE 400
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4667
Practice Address - Country:US
Practice Address - Phone:503-494-8766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3884840002Medicare NSC