Pam Ebert OD LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

3484AT Issued in OR

Legal business name

PAM EBERT OD LLC

Doing business as

Custom Eyes

Practice address

1871 2ND St
Springfield, OR 97477-2121

Phone

(541) 741-0122

NPI assigned

Dec 14, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Pam Ebert, OD

Title

Owner

Phone

(541) 741-0122

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Custom Eyes Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435536000000",
    "number": "1750650131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1871 2ND ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974772121",
            "telephone_number": "541-741-0122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1871 2ND ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974772121",
            "telephone_number": "541-741-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAM EBERT OD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-14",
        "last_updated": "2015-06-29",
        "status": "A",
        "authorized_official_last_name": "EBERT",
        "authorized_official_first_name": "PAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-741-0122",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": "3484AT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "R174133",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Eyes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bradley D Palmen, MD
• Kristi Palmer Kaag, MED
• Carolyn Palmer Luethe, LAC, RN
• Sara H Palmer, MS
• Paloma Palomarez
• Samantha Paramore, RN
• Christopher Andrew Park, OTR
• Harry H Park, MD
• Jocelyn A Park, M.D.
• Priscilla Stewart Park, MD

• Clinic/Center in Springfield, OR
• Providers in Springfield, OR by specialty
• Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.