MEDICARE: NORTHWEST EYE CENTER, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1134299241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST EYE CENTER, PC

Provider Business Mailing Address
First Line	:	2435 NW KLINE ST
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-1690
Country	:	US
Telephone Number	:	541-672-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	2435 NW KLINE ST
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-1690
Country	:	US
Telephone Number	:	541-672-2020
Fax Number	:

Authorized Official
Title or Position	:	OWNER-PRESIDENT
Name	:	DR. JON-MARC WESTON
Credential	:	MD
Telephone Number	:	541-672-2020

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	10/27/2010

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