Healthcare Provider Details

I. General information

NPI: 1932433695
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: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 SW BARNES RD STE 100
PORTLAND OR
97225-6668
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: 503-557-2020
  • 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: 503-344-5101