Provider Demographics
NPI:1972835882
Name:EYESTYLES LLC
Entity Type:Organization
Organization Name:EYESTYLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:THORSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-372-5013
Mailing Address - Street 1:7367 SW BRIDGEPORT RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7710
Mailing Address - Country:US
Mailing Address - Phone:503-372-5013
Mailing Address - Fax:503-430-0951
Practice Address - Street 1:7367 SW BRIDGEPORT RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7710
Practice Address - Country:US
Practice Address - Phone:503-372-5013
Practice Address - Fax:503-430-0951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00004340332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier