Provider Demographics
NPI:1700982006
Name:DARRELL E GENSTLER MD PC
Entity Type:Organization
Organization Name:DARRELL E GENSTLER MD PC
Other - Org Name:THE EYEWEAR PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GENSTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-928-1667
Mailing Address - Street 1:2700 14TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322
Mailing Address - Country:US
Mailing Address - Phone:541-928-1667
Mailing Address - Fax:541-928-1817
Practice Address - Street 1:2700 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322
Practice Address - Country:US
Practice Address - Phone:541-928-1667
Practice Address - Fax:541-928-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1169500001Medicare ID - Type Unspecified