WALDPORT EYE CARE LLC NPI 1366633679

Optometrist in Waldport, OR

NPI 1366633679 Organization Optometrist

About WALDPORT EYE CARE LLC

Waldport Eye Care Llc is a provider established in Waldport, Oregon specializing in optometrist. The NPI number of Waldport Eye Care Llc is 1366633679 and was assigned on August 2007. The practitioner's primary taxonomy code is 152W00000X. The provider is registered as an organization and their NPI record was last updated 14 years ago. Waldport Eye Care Llc operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Dr. Kevin Dean Blair Od (Member)

NPI

1366633679

Provider NameWALDPORT EYE CARE LLC
Provider Location Address525 NW WILLOW WALDPORT, OR 97394
Provider Mailing AddressPO BOX 888 WALDPORT, OR 97394
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date08-05-2007
Last Update Date03-13-2008


Primary Taxonomy

Taxonomy Code152W00000X
ClassificationOptometrist
TypeEye and Vision Services Providers
Taxonomy DescriptionDoctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

Business Address

WALDPORT EYE CARE LLC
525 NW WILLOW
WALDPORT, OR
ZIP 97394
Phone: (541) 563-4100
Fax: (541) 563-4468

Get Directions


Mailing Address

WALDPORT EYE CARE LLC
PO BOX 888
WALDPORT, OR
ZIP 97394
Phone: (541) 563-4100
Fax: (541) 563-4468



Authorized Official

Authorized Official NameDR. KEVIN DEAN BLAIR OD
Authorized Official TitleMEMBER
Authorized Official Phone(541) 563-4100

Group Taxonomy


193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
299057MEDICAID (05)OR
139379MEDICARE PIN (08)OR
R139379MEDICARE PIN (08)OR

Other Providers at the same location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1366591026DR. RODNEY W BOURDAGE O.D.
Individual
Optometrist525 NW WILLOW
WALDPORT, OR 97394
(541) 563-4100

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.