Healthcare Provider Details

I. General information

NPI: 1316932122
Provider Name (Legal Business Name): OREGON EYE SURGERY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 OAK ST
EUGENE OR
97401-7701
US

IV. Provider business mailing address

1550 OAK ST SUITE #2
EUGENE OR
97401-7701
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-4988
  • Fax: 541-434-0960
Mailing address:
  • Phone: 541-484-4988
  • Fax: 541-434-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number07-1525
License Number StateOR

VIII. Authorized Official

Name: KEYHAN F ARYAH
Title or Position: SECRETARY / TREASURER
Credential: M.D.
Phone: 541-484-3937