Healthcare Provider Details

I. General information

NPI: 1003941873
Provider Name (Legal Business Name): PENDLETON EYE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SOUTHGATE STE A
PENDLETON OR
97801-3977
US

IV. Provider business mailing address

1050 SOUTHGATE STE A
PENDLETON OR
97801-3977
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-4752
  • Fax: 541-278-2918
Mailing address:
  • Phone: 541-276-4752
  • Fax: 541-278-2918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number152W0000X
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number207W0000X
License Number StateOR

VIII. Authorized Official

Name: DR. BART A ADAMS
Title or Position: PHYICIAN
Credential: M.D.
Phone: 541-276-4752