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General NPI Number Information
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NPI Number | 1245671924
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Entity Type | Organization
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Legal Business Name | MASTER EYE ASSOCIATES, P.C.
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 07/23/2013
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Provider Practice Location Address
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Address Line | 18070 NW EVERGREEN PKWY
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City | BEAVERTON
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State | OR
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Zip | 97006-7451
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Country | US
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Telephone | 503-645-5076
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 629
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City | WEST LINN
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State | OR
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Zip | 97068-0629
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Country | US
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Telephone |
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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. TONY GENDVILAS
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Credential | O.D.
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Telephone | 503-807-6969
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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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