Healthcare Provider Details

I. General information

NPI: 1255419909
Provider Name (Legal Business Name): EUGENE EYEWEAR, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 COBURG RD SUITE 105
EUGENE OR
97401
US

IV. Provider business mailing address

207 COBURG RD SUITE 105
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-338-4844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: STEVE JUNG
Title or Position: OWNER/OPTOMETRIST
Credential: O.D.
Phone: 541-338-4844