Provider Demographics
NPI:1770699860
Name:HAWTHORNE VISION CENTER PC
Entity type:Organization
Organization Name:HAWTHORNE VISION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:UHLIG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-235-6639
Mailing Address - Street 1:4704 SE HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215
Mailing Address - Country:US
Mailing Address - Phone:503-235-6639
Mailing Address - Fax:503-235-2263
Practice Address - Street 1:4704 SE HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215
Practice Address - Country:US
Practice Address - Phone:503-235-6639
Practice Address - Fax:503-235-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0621460001Medicare NSC
ORR106347Medicare PIN