Healthcare Provider Details

I. General information

NPI: 1275800559
Provider Name (Legal Business Name): WILLIAM R. LOSIE O.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 CHAMBERS ST SUITE 101
EUGENE OR
97402-3655
US

IV. Provider business mailing address

1680 CHAMBERS ST SUITE 101
EUGENE OR
97402-3655
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-1117
  • Fax: 541-687-2158
Mailing address:
  • Phone: 541-686-1117
  • Fax: 541-687-2158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1709ATI
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1709ATI
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1709ATI
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1709ATI
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number1709ATI
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1709ATI
License Number StateOR
# 7
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number1709ATI
License Number StateOR
# 8
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM RAY LOSIE
Title or Position: PRESIDENT
Credential: O.D.
Phone: 541-686-1117