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General NPI Number Information
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NPI Number | 1851601561
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Entity Type | Organization
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Legal Business Name | RIVER VIEW FAMILY EYECARE, LLC
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 609 HICKORY ST NW STE. 160
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City | ALBANY
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State | OR
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Zip | 97321-1763
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Country | US
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Telephone | 541-967-3097
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Fax |
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Provider Business Mailing Address
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Address Line | 27652 FERN RIDGE RD
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City | SWEET HOME
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State | OR
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Zip | 97386-9529
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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 | MANAGER
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Name | DR. KELLY G. BATEY
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Credential | O.D.
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Telephone | 901-652-7312
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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 | 3346ATI
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License Number State | OR
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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 | 3304ATI
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License Number State | OR
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