Healthcare Provider Details

I. General information

NPI: 1255786265
Provider Name (Legal Business Name): DOMINIC LEMAS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 PEARL ST
EUGENE OR
97401-4009
US

IV. Provider business mailing address

655 GOODPASTURE ISLAND RD APT 196
EUGENE OR
97401-1534
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-1237
  • Fax:
Mailing address:
  • Phone: 503-740-7480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberATI-4358
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: