Healthcare Provider Details

I. General information

NPI: 1033388681
Provider Name (Legal Business Name): OREGON EYE SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19250 SW 65TH AVE STE 215
TUALATIN OR
97062-7707
US

IV. Provider business mailing address

6420 S MACADAM AVE STE 160
PORTLAND OR
97239-3517
US

V. Phone/Fax

Practice location:
  • Phone: 503-692-3630
  • Fax:
Mailing address:
  • Phone: 503-244-8601
  • Fax: 503-244-3013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DEVIN GATTEY
Title or Position: OPHTHALMOLOGIST, COMPANY PRESIDENT
Credential: MD
Phone: 503-244-8601