Provider Demographics
NPI:1184081408
Name:OCEANLAKE VETERINARY CLINIC, PC
Entity type:Organization
Organization Name:OCEANLAKE VETERINARY CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VETERINARIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DVM
Authorized Official - Phone:541-994-2929
Mailing Address - Street 1:3545 NW HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-5047
Mailing Address - Country:US
Mailing Address - Phone:541-994-2929
Mailing Address - Fax:541-994-7560
Practice Address - Street 1:3545 NW HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-5047
Practice Address - Country:US
Practice Address - Phone:541-994-2929
Practice Address - Fax:541-994-7560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-16
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6457174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174M00000XOther Service ProvidersVeterinarianGroup - Multi-Specialty