Provider Demographics
NPI:1881893626
Name:EAGLES, KEIRSTEN DANEE (OD)
Entity type:Individual
Prefix:DR
First Name:KEIRSTEN
Middle Name:DANEE
Last Name:EAGLES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1404
Mailing Address - Country:US
Mailing Address - Phone:503-873-8619
Mailing Address - Fax:503-873-8282
Practice Address - Street 1:600 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1404
Practice Address - Country:US
Practice Address - Phone:503-873-8619
Practice Address - Fax:503-873-8282
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3228ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist