Provider Demographics
NPI:1932459815
Name:INDIAN CREEK FAMILY EYE CARE PC
Entity Type:Organization
Organization Name:INDIAN CREEK FAMILY EYE CARE PC
Other - Org Name:INDIAN CREEK FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:CHOWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-754-5625
Mailing Address - Street 1:1700 12TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-9540
Mailing Address - Country:US
Mailing Address - Phone:541-386-1700
Mailing Address - Fax:541-386-1702
Practice Address - Street 1:1700 12TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-9540
Practice Address - Country:US
Practice Address - Phone:503-754-5625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2929ATI261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service