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General NPI Number Information
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NPI Number | 1629156187
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Entity Type | Organization
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Legal Business Name | NORTHWEST EYE ASSOCIATES LLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 2222 NW LOVEJOY ST SUITE 504
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City | PORTLAND
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State | OR
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Zip | 97210-3033
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Country | US
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Telephone | 503-227-6568
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Fax | 503-227-3919
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Provider Business Mailing Address
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Address Line | 2222 NW LOVEJOY ST SUITE 504
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City | PORTLAND
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State | OR
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Zip | 97210-3033
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Country | US
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Telephone | 503-227-6568
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Fax | 503-227-3919
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Authorized Official
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Title or Position | OWNER PARTNER
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Name | JENNIFER BALENTINE
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Credential | MD
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Telephone | 503-227-6568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 680887
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License Number State | OR
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