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General NPI Number Information
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NPI Number | 1477704310
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Entity Type | Organization
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Legal Business Name | FAMILY EYE CENTER PA
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 1257 SW 4TH AVE
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City | ONTARIO
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State | OR
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Zip | 97914-4516
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Country | US
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Telephone | 541-889-2191
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Fax | 541-881-1523
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Provider Business Mailing Address
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Address Line | 1257 SW 4TH AVE
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City | ONTARIO
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State | OR
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Zip | 97914-4516
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Country | US
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Telephone | 541-889-2191
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Fax | 541-881-1523
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDY H NORRIS
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Credential | OD
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Telephone | 541-889-2191
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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 | ODP-100098
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3386AT
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License Number State | OR
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