Healthcare Provider Details

I. General information

NPI: 1265565832
Provider Name (Legal Business Name): EASON ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 VALLEY RIVER WAY SUITE 107B
EUGENE OR
97401-2127
US

IV. Provider business mailing address

1011 VALLEY RIVER WAY SUITE 107B
EUGENE OR
97401-2127
US

V. Phone/Fax

Practice location:
  • Phone: 541-242-3668
  • Fax: 541-542-3373
Mailing address:
  • Phone: 541-242-3668
  • Fax: 541-542-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number332BC3200X
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier80449000
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerREGENCE BCBS SUPPLIER ID
# 2
Identifier227879
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: JOHN EASON
Title or Position: OWNER
Credential: CERTIFIED PEDOTHIST
Phone: 541-242-3668