Healthcare Provider Details

I. General information

NPI: 1003215807
Provider Name (Legal Business Name): SILVERTON EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W MAIN ST
SILVERTON OR
97381-2019
US

IV. Provider business mailing address

114 W MAIN ST
SILVERTON OR
97381-2019
US

V. Phone/Fax

Practice location:
  • Phone: 503-873-2788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3228ATI
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number3228ATI
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number3228ATI
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number3228ATI
License Number StateOR

VIII. Authorized Official

Name: DR. KEIRSTEN DANEE EAGLES
Title or Position: OWNER
Credential: O.D.
Phone: 503-881-5486