Healthcare Provider Details

I. General information

NPI: 1821472960
Provider Name (Legal Business Name): COMPLETE EYE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NW 20TH ST STE 100
GRESHAM OR
97030-2442
US

IV. Provider business mailing address

500 NW 20TH ST STE 100
GRESHAM OR
97030-2442
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 Number
License Number State

VIII. Authorized Official

Name: SHARON E NEAL
Title or Position: SECRETARY
Credential:
Phone: 503-667-2020