Healthcare Provider Details

I. General information

NPI: 1477704310
Provider Name (Legal Business Name): FAMILY EYE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1257 SW 4TH AVE
ONTARIO OR
97914-4516
US

IV. Provider business mailing address

1257 SW 4TH AVE
ONTARIO OR
97914-4516
US

V. Phone/Fax

Practice location:
  • Phone: 541-889-2191
  • Fax: 541-881-1523
Mailing address:
  • Phone: 541-889-2191
  • Fax: 541-881-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODP-100098
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3386AT
License Number StateOR

VIII. Authorized Official

Name: DR. RANDY H NORRIS
Title or Position: OWNER
Credential: OD
Phone: 541-889-2191