Waldport Eye Care LLC
Organization Active NPI Optometrist · Waldport, OR
NPI 1366633679 · NPPES record last updated Mar 13, 2008
Key facts
- NPI
- 1366633679
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- WALDPORT EYE CARE LLC
- Practice address
- 525 NW Willow
Waldport, OR 97394 - Phone
- (541) 563-4100
- Fax
- (541) 563-4468
- NPI assigned
- Aug 5, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Kevin Dean Blair, OD
- Title
- Member
- Phone
- (541) 563-4100
Practitioners 4
-
Kevin Dean Blair, OD
-
Merle Nye Berry, OD
-
Rodney W Bourdage, O.D.
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
525 NW Willow
Waldport, OR 97394
Mailing address
PO Box 888
Waldport, OR 97394-0888
Phone (541) 563-4100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 299057 | Medicaid | OR |
Other providers in Waldport, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.