Healthcare Provider Details

I. General information

NPI: 1255827689
Provider Name (Legal Business Name): WOODBURN EYE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 GLATT CIR
WOODBURN OR
97071-7690
US

IV. Provider business mailing address

580 GLATT CIR
WOODBURN OR
97071-7690
US

V. Phone/Fax

Practice location:
  • Phone: 503-982-3937
  • Fax:
Mailing address:
  • Phone: 503-982-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SCOTT L NEHRING
Title or Position: OWNER
Credential: O.D.
Phone: 503-982-3937