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General NPI Number Information
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NPI Number | 1124125596
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Entity Type | Organization
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Legal Business Name | GENSTLER EYE CENTER
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 2700 14TH AVE SE
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City | ALBANY
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State | OR
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Zip | 97322
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Country | US
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Telephone | 541-928-1667
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Fax | 541-928-1817
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Provider Business Mailing Address
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Address Line | 2700 14TH AVE SE
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City | ALBANY
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State | OR
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Zip | 97322-6956
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Country | US
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Telephone | 541-928-1667
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Fax | 541-928-1817
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Authorized Official
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Title or Position | OWNER
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Name | DARRELL GENSTLER
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Credential | MD
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Telephone | 541-928-1667
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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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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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