MEDICARE: EAGLE EYE VISION CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3288ATI	OR

General Provider Information

NPI Number	:	1598001844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE EYE VISION CARE LLC

Provider Business Mailing Address
First Line	:	4048 RIVER RD N
Second Line	:
City	:	KEIZER
State	:	OR
Zip	:	97303-5501
Country	:	US
Telephone Number	:	503-385-8361
Fax Number	:	503-385-8364

Provider Business Practice Location Address
First Line	:	4048 RIVER ROAD NORTH
Second Line	:
City	:	KEIZER
State	:	OR
Zip	:	97303
Country	:	US
Telephone Number	:	503-385-8361
Fax Number	:	503-385-8364

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. KEIRSTEN DANEE EAGLES
Credential	:	O.D.
Telephone Number	:	503-385-8361

Provider Enumeration Date	:	12/13/2012
Last Update Date	:	12/13/2012

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Directions to “EAGLE EYE VISION CARE LLC ” Practice Location

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