Healthcare Provider Details

I. General information

NPI: 1639014012
Provider Name (Legal Business Name): EYEONIAN LLC DBA EYES ON WALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 NW WALL ST
BEND OR
97703-2715
US

IV. Provider business mailing address

822 NW WALL ST
BEND OR
97703-2715
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-4756
  • Fax: 541-382-4455
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: JAKOB TALBO
Title or Position: OWNER
Credential:
Phone: 310-774-7475