Healthcare Provider Details

I. General information

NPI: 1285936773
Provider Name (Legal Business Name): TODAY'S VISION CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BRUTSCHER ST STE E
NEWBERG OR
97132-6096
US

IV. Provider business mailing address

901 BRUTSCHER ST STE E
NEWBERG OR
97132-6096
US

V. Phone/Fax

Practice location:
  • Phone: 503-554-5555
  • Fax: 503-538-1896
Mailing address:
  • Phone: 503-554-5555
  • Fax: 503-538-1896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2591ATI
License Number StateOR

VIII. Authorized Official

Name: DR. JOSE MARIN JR.
Title or Position: OWNER
Credential: OD
Phone: 503-554-5555