Healthcare Provider Details

I. General information

NPI: 1992783468
Provider Name (Legal Business Name): ANN ADELE EASLY-DEBISSCHOP O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 02/08/2008
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: 541-889-9675
Mailing address:
  • Phone: 541-889-2020
  • Fax: 541-889-9675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1686AT
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: