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General NPI Number Information
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NPI Number | 1063982239
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Entity Type | Organization
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Legal Business Name | OREGON PHYSICIANS EYECARE GROUP, P.C.
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Dates
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Enumeration Date | 11/30/2018
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 305 NW BURNSIDE RD
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City | GRESHAM
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State | OR
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Zip | 97030-3851
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Country | US
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Telephone | 971-220-5605
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Fax | 503-912-5202
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Provider Business Mailing Address
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Address Line | 1615 S CONGRESS AVE STE 105
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6326
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Country | US
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Telephone | 561-275-2020
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Fax |
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Authorized Official
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Title or Position | SENIOR REVENUE CYCLE MANAGER
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Name | ALISHA JACKSON
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Credential |
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Telephone | 561-208-1591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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