Provider Demographics
NPI:1952610149
Name:ANN A EASLY OD PC
Entity type:Organization
Organization Name:ANN A EASLY OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:A
Authorized Official - Last Name:EASLY-DEBISSCHOP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-889-2020
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-0220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:279 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2135
Practice Address - Country:US
Practice Address - Phone:541-889-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1686ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1992783468OtherNPI
OR271296Medicaid
ORR0000PHDWZMedicare PIN
OR271296Medicaid