Provider Demographics
NPI:1962686527
Name:DELWIN GARY FLINT & BECKY A COLLIER
Entity Type:Organization
Organization Name:DELWIN GARY FLINT & BECKY A COLLIER
Other - Org Name:UMATILLA VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:5 PERCENT OR MORE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-567-0142
Mailing Address - Street 1:455 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-1926
Mailing Address - Country:US
Mailing Address - Phone:541-567-0142
Mailing Address - Fax:
Practice Address - Street 1:455 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1926
Practice Address - Country:US
Practice Address - Phone:541-567-0142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0589250001Medicare NSC