OREGON EYE SPECIALISTS PC

Provider Demographics

• NPI: 1487721023
• Name: OREGON EYE SPECIALISTS PC
• Entity type: Organization
• Organization Name: OREGON EYE SPECIALISTS PC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: OPHTHALMOLOGIST, COMPANY PRESIDENT
• Authorized Official - First Name: DEVIN
• Authorized Official - Middle Name: M
• Authorized Official - Last Name: GATTEY
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 503-244-8601
• Mailing Address - Street 1: 6420 S MACADAM AVE STE 160
• Mailing Address - City: PORTLAND
• Mailing Address - State: OR
• Mailing Address - Zip Code: 97239-3517
• Mailing Address - Country: US
• Mailing Address - Phone: 503-244-8601
• Mailing Address - Fax: 503-244-3013
• Practice Address - Street 1: 6420 S MACADAM AVE STE 160
• Practice Address - City: PORTLAND
• Practice Address - State: OR
• Practice Address - Zip Code: 97239-3517
• Practice Address - Country: US
• Practice Address - Phone: 503-244-8601
• Practice Address - Fax: 503-244-3013
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-11-29
• Last Update Date: 2020-07-07

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207W00000X	Allopathic & Osteopathic Physicians	Ophthalmology		Group - Single Specialty
No	332H00000X	Suppliers	Eyewear Supplier		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
OR	07894-4	Medicaid
OR	14958-3	Medicaid
OR	22634-4	Medicaid
	CS5592	Other	RR MEDICARE PTAN
OR	02262-6	Medicaid
OR	06527-1	Medicaid
OR	22633-5	Medicaid
OR	26075-2	Medicaid
OR	02557-2	Medicaid
OR	04877-7	Medicaid
OR	23334-9	Medicaid
	CH568	Other	RR MEDICARE PTAN
OR	27152-8	Medicaid
OR	27665-8	Medicaid
OR	28849-0	Medicaid
	DA3276	Other	RR MEDICARE PTAN
OR	21536-8	Medicaid
OR	22935-3	Medicaid
OR	06008-7	Medicaid
OR	28849-0	Medicaid
OR	26075-2	Medicaid
OR	0769880014	Medicare NSC
OR	0769880013	Medicare NSC
OR	21536-8	Medicaid
OR	07894-4	Medicaid
OR	0769880005	Medicare NSC
OR	0769880012	Medicare NSC
OR	0000WCTBY	Medicare PIN
	CS5592	Other	RR MEDICARE PTAN
OR	22633-5	Medicaid
OR	02557-2	Medicaid
OR	04877-7	Medicaid
OR	06008-7	Medicaid
OR	0000WCQKS	Medicare PIN