=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467132845
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYE COMFORT CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2023
-----------------------------------------------------
Last Update Date | 07/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 57765 NW WILSON RIVER HWY
-----------------------------------------------------
City | GALES CREEK
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97117-9359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-703-0490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 57765 NW WILSON RIVER HWY
-----------------------------------------------------
City | GALES CREEK
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97117-9359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | VIVIAN SURYA BUEHLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 971-703-0490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------