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General NPI Number Information
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NPI Number | 1215313440
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Entity Type | Organization
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Legal Business Name | VISUAL EYES LLC
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 320 N COLUMBIA ST
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City | MILTON FREEWATER
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State | OR
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Zip | 97862-9405
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Country | US
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Telephone | 541-212-8685
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Fax |
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Provider Business Mailing Address
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Address Line | 320 N COLUMBIA ST
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City | MILTON FREEWATER
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State | OR
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Zip | 97862-9405
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Country | US
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Telephone | 541-212-8685
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BENJAMIN STOWE WINTERS
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Credential | O.D.
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Telephone | 541-938-5888
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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 | 3503
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License Number State | OR
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