Provider Demographics
NPI:1205924206
Name:THE SPECTOR GROUP, INC.
Entity type:Organization
Organization Name:THE SPECTOR GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GURTISEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-492-3897
Mailing Address - Street 1:226 E HISTORIC COLUMBIA RIVER HWY
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-2069
Mailing Address - Country:US
Mailing Address - Phone:503-492-3897
Mailing Address - Fax:503-665-4137
Practice Address - Street 1:226 E HISTORIC COLUMBIA RIVER HWY
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-2069
Practice Address - Country:US
Practice Address - Phone:503-492-3897
Practice Address - Fax:503-665-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2320T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR031497Medicaid
WA2019628Medicaid
OR00WFBSVAMedicare ID - Type Unspecified
OR031497Medicaid
ORU19271Medicare UPIN