Provider Demographics
NPI:1952611758
Name:SYNERGY EYE, LLC
Entity Type:Organization
Organization Name:SYNERGY EYE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLOSSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-207-0630
Mailing Address - Street 1:12781 NW FOREST SPRING LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-9362
Mailing Address - Country:US
Mailing Address - Phone:503-690-6787
Mailing Address - Fax:
Practice Address - Street 1:220 N ADAIR STREET
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:OR
Practice Address - Zip Code:97113
Practice Address - Country:US
Practice Address - Phone:503-207-0630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty