Healthcare Provider Details

I. General information

NPI: 1326460221
Provider Name (Legal Business Name): MT. HOOD EYE CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2014
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36840 INDUSTRIAL WAY STE D
SANDY OR
97055-9254
US

IV. Provider business mailing address

36840 INDUSTRIAL WAY STE D
SANDY OR
97055-9254
US

V. Phone/Fax

Practice location:
  • Phone: 503-484-8663
  • Fax:
Mailing address:
  • Phone: 503-484-8663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3371ATI
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY JAMES TURIN
Title or Position: CEO
Credential: O.D. F.A.A.O.
Phone: 503-482-0475