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General NPI Number Information
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NPI Number | 1891923041
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Entity Type | Organization
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Legal Business Name | DV EYE CARE LLC
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 405 MEADOW CT UNIT A
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City | LA GRANDE
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State | OR
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Zip | 97850-1271
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Country | US
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Telephone | 503-799-4110
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Fax |
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Provider Business Mailing Address
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Address Line | 405 MEADOW CT UNIT A
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City | LA GRANDE
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State | OR
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Zip | 97850-1271
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Country | US
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Telephone | 503-799-4110
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | NATHAN FRANK
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Credential | O.D.
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Telephone | 503-799-4110
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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 | 3273ATI
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License Number State | OR
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