Healthcare Provider Details

I. General information

NPI: 1669706313
Provider Name (Legal Business Name): EYE HEALTH NORTHWEST P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 NW NORTHRUP ST
PORTLAND OR
97209-1614
US

IV. Provider business mailing address

11086 SE OAK ST
MILWAUKIE OR
97222-6692
US

V. Phone/Fax

Practice location:
  • Phone: 503-227-2020
  • Fax: 503-222-0614
Mailing address:
  • Phone: 503-558-7372
  • Fax: 503-344-5110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRETT M WILLIAMS
Title or Position: CEO
Credential:
Phone: 503-558-7372