MEDICARE: APPLE EYECARE 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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1538345269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLE EYECARE PC

Provider Business Mailing Address
First Line	:	10709 WALTON ROAD
Second Line	:
City	:	ISLAND CITY
State	:	OR
Zip	:	97850
Country	:	US
Telephone Number	:	541-962-7753
Fax Number	:	541-963-0750

Provider Business Practice Location Address
First Line	:	10709 WALTON ROAD
Second Line	:
City	:	ISLAND CITY
State	:	OR
Zip	:	97850
Country	:	US
Telephone Number	:	541-962-7753
Fax Number	:	541-963-0750

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	BARBARA A BECKNER
Credential	:
Telephone Number	:	541-962-7753

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	02/24/2011

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