Provider Demographics
NPI:1811174550
Name:CENTRAL OREGON EYECARE, PC
Entity type:Organization
Organization Name:CENTRAL OREGON EYECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELLISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FELLINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-548-2488
Mailing Address - Street 1:1000 SW INDIAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756
Mailing Address - Country:US
Mailing Address - Phone:541-548-2488
Mailing Address - Fax:541-548-5334
Practice Address - Street 1:198 NE COMBS FLAT RD, STE 120
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754
Practice Address - Country:US
Practice Address - Phone:541-447-5133
Practice Address - Fax:541-447-6891
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL OREGON EYECARE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2823ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5032580003Medicare NSC
ORR117490Medicare PIN
ORR117490Medicare UPIN