Provider Demographics
NPI:1992830186
Name:EYE CARE PHYSICIANS & SURGEONS, INC
Entity Type:Organization
Organization Name:EYE CARE PHYSICIANS & SURGEONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ORVAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-585-2022
Mailing Address - Street 1:1309 LIBERTY ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4245
Mailing Address - Country:US
Mailing Address - Phone:503-585-2022
Mailing Address - Fax:503-378-0797
Practice Address - Street 1:1309 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4245
Practice Address - Country:US
Practice Address - Phone:503-585-2022
Practice Address - Fax:503-378-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR165456Medicaid
OR165456Medicaid
0581530001Medicare NSC