Provider Demographics
NPI:1437203858
Name:NORTHWEST EYE CENTER PC
Entity type:Organization
Organization Name:NORTHWEST EYE CENTER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:BELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-672-2020
Mailing Address - Street 1:2435 NW KLINE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1690
Mailing Address - Country:US
Mailing Address - Phone:541-672-2020
Mailing Address - Fax:541-673-8084
Practice Address - Street 1:2435 NW KLINE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1690
Practice Address - Country:US
Practice Address - Phone:541-672-2020
Practice Address - Fax:541-673-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR102771Medicare ID - Type Unspecified
ORR161760Medicare PIN
OR4117460001Medicare NSC