=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043769227
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST LINN VISION CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2016
-----------------------------------------------------
Last Update Date | 04/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 8TH AVE SUITE A
-----------------------------------------------------
City | WEST LINN
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97068-4657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-652-1479
-----------------------------------------------------
Fax | 503-303-5587
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2020 8TH AVE SUITE A
-----------------------------------------------------
City | WEST LINN
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97068-4657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-652-1479
-----------------------------------------------------
Fax | 503-303-5587
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TODD MICHAEL SHELDON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 541-548-2488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------