Provider Demographics
NPI:1255793519
Name:ODYSSEY SCIENCE INNOVATIONS, LLC
Entity type:Organization
Organization Name:ODYSSEY SCIENCE INNOVATIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-577-7571
Mailing Address - Street 1:6 CENTERPOINTE DR STE 450
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8621
Mailing Address - Country:US
Mailing Address - Phone:503-489-8929
Mailing Address - Fax:
Practice Address - Street 1:6 CENTERPOINTE DR STE 450
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8621
Practice Address - Country:US
Practice Address - Phone:503-489-8929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty