MEDICARE: EYE HEALTH NORTHWEST P.C.

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	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821322587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE HEALTH NORTHWEST P.C.

Provider Business Mailing Address
First Line	:	11086 SE OAK ST
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-6692
Country	:	US
Telephone Number	:	503-557-2020
Fax Number	:	503-344-5110

Provider Business Practice Location Address
First Line	:	24601 SE STARK ST
Second Line	:
City	:	TROUTDALE
State	:	OR
Zip	:	97060-3355
Country	:	US
Telephone Number	:	503-667-2431
Fax Number	:	503-252-1797

Authorized Official
Title or Position	:	CEO
Name	:	DR. BRETT M WILLIAMS
Credential	:
Telephone Number	:	503-344-5101

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	12/21/2021

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Directions to “EYE HEALTH NORTHWEST P.C. ” Practice Location

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