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NPI Code Detail

MEDICARE: EYE HEALTH NORTHWEST OPTICAL, LLC

MEDICARE: EYE HEALTH NORTHWEST OPTICAL, LLC
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
1332H00000XEyewear Supplier

General Provider Information

NPI Number : 1750363958
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYE HEALTH NORTHWEST OPTICAL, LLC
Provider Business Mailing Address
First Line : PO BOX 22009
Second Line :
City : MILWAUKIE
State : OR
Zip : 97269-2009
Country : US
Telephone Number : 503-557-2020
Fax Number : 503-344-5110
Provider Business Practice Location Address
First Line : 1306 DIVISION ST
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-1523
Country : US
Telephone Number : 503-656-4221
Fax Number : 503-656-4249
Authorized Official
Title or Position : PRESIDENT
Name : DR. ROBERT WELLS BENTLEY
Credential : MD
Telephone Number : 503-557-2020
Provider Enumeration Date : 11/15/2005
Last Update Date : 09/17/2008

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Directions to “EYE HEALTH NORTHWEST OPTICAL, LLC ” Practice Location

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