Healthcare Provider Details

I. General information

NPI: 1477174670
Provider Name (Legal Business Name): NEWBERG FAMILY EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N BRUTSCHER ST STE E
NEWBERG OR
97132-6096
US

IV. Provider business mailing address

901 N BRUTSCHER ST STE E
NEWBERG OR
97132-6096
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIKA C BURY
Title or Position: OPTOMETRIST
Credential: OD
Phone: 443-610-3458