Healthcare Provider Details

I. General information

NPI: 1114939444
Provider Name (Legal Business Name): EYE CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NW 20TH ST
GRESHAM OR
97030-2441
US

IV. Provider business mailing address

500 NW 20TH ST
GRESHAM OR
97030-2441
US

V. Phone/Fax

Practice location:
  • Phone: 503-667-2020
  • Fax: 503-667-6386
Mailing address:
  • Phone: 503-667-2020
  • Fax: 503-667-6386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD06318
License Number StateOR

VIII. Authorized Official

Name: DEAN E NEAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 503-667-2020