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General NPI Number Information
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NPI Number | 1861746331
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Entity Type | Organization
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Legal Business Name | TUALATIN EYE ASSOCIATES PC
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 18801 SW BOONES FERRY
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City | TUALATIN
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State | OR
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Zip | 97062
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Country | US
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Telephone | 503-692-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 18801 SW BOONES FERRY
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City | TUALATIN
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State | OR
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Zip | 97062
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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 | CEO
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Name | DR. CRAIG E BOWEN
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Credential | OD
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Telephone | 503-692-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1813ATI
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License Number State | OR
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