Healthcare Provider Details

I. General information

NPI: 1992870604
Provider Name (Legal Business Name): RAINBOW OPTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W 18TH AVE
EUGENE OR
97402-3625
US

IV. Provider business mailing address

1740 W 18TH AVE
EUGENE OR
97402-3625
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-5555
  • Fax: 541-334-7605
Mailing address:
  • Phone: 541-343-5555
  • 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: DR. DARAN M DECALESTA
Title or Position: PRESIDENT
Credential: O.D.
Phone: 541-343-5555