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General NPI Number Information
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NPI Number | 1508970898
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Entity Type | Organization
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Legal Business Name | COMPLETE VISION CENTER, P.C.
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 1717 CENTENNIAL BLVD SUITE 2
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City | SPRINGFIELD
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State | OR
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Zip | 97477-3378
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Country | US
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Telephone | 541-747-0616
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Fax | 541-747-0617
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Provider Business Mailing Address
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Address Line | 1717 CENTENNIAL BLVD SUITE 2
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City | SPRINGFIELD
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State | OR
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Zip | 97477-3378
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Country | US
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Telephone | 541-747-0616
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Fax | 541-747-0617
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. TREVOR JOHN CLEVELAND
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Credential | O.D.
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Telephone | 541-747-0616
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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 | 2697T
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License Number State | OR
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