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General NPI Number Information
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NPI Number | 1457766859
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Entity Type | Organization
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Legal Business Name | EYEDEOLOGY, INC
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 5656 HOOD ST. STE 107
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City | WEST LINN
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State | OR
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Zip | 97068
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Country | US
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Telephone | 808-799-4555
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Fax |
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Provider Business Mailing Address
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Address Line | 3652 Z ST
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City | WASHOUGAL
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State | WA
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Zip | 98671
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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 | PRESIDENT
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Name | DR. NICOLETA PEARCE
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Credential | OD
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Telephone | 808-799-4555
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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 | 2894T
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License Number State | OR
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