Healthcare Provider Details

I. General information

NPI: 1952610149
Provider Name (Legal Business Name): ANN A EASLY OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 SW 10TH ST
ONTARIO OR
97914-2135
US

IV. Provider business mailing address

PO BOX 220
ONTARIO OR
97914-0220
US

V. Phone/Fax

Practice location:
  • Phone: 541-889-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1686ATI
License Number StateOR

VIII. Authorized Official

Name: DR. ANN A EASLY-DEBISSCHOP
Title or Position: OWNER/DOCTOR
Credential: OD
Phone: 541-889-2020