MEDICARE: RETINA CLINIC OF THE CASCADES, 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	207W00000X	Ophthalmology Physician	MD22414	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447241062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA CLINIC OF THE CASCADES, PC

Provider Business Mailing Address
First Line	:	2275 NE DOCTORS DR
Second Line	:	STE 2
City	:	BEND
State	:	OR
Zip	:	97701-6324
Country	:	US
Telephone Number	:	541-693-5050
Fax Number	:	541-693-5051

Provider Business Practice Location Address
First Line	:	2275 NE DOCTORS DR
Second Line	:	STE 2
City	:	BEND
State	:	OR
Zip	:	97701-6324
Country	:	US
Telephone Number	:	541-693-5050
Fax Number	:	541-693-5051

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN P BERREEN
Credential	:	MD
Telephone Number	:	541-693-5050

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	11/21/2008

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