Healthcare Provider Details

I. General information

NPI: 1083246292
Provider Name (Legal Business Name): GATTI VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15405 SW 116TH AVE STE 204
KING CITY OR
97224-4101
US

IV. Provider business mailing address

15405 SW 116TH AVE STE 204
KING CITY OR
97224-4101
US

V. Phone/Fax

Practice location:
  • Phone: 971-371-3927
  • Fax: 888-411-0427
Mailing address:
  • Phone: 971-371-3927
  • Fax: 888-411-0427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ALEX HEIBERG
Title or Position: OFFICE MANAGER
Credential:
Phone: 971-371-3927