Provider Demographics
NPI:1902296817
Name:CEDAR MILL ELITE EYE CARE, P.C.
Entity Type:Organization
Organization Name:CEDAR MILL ELITE EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MERSEDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFARI SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:971-645-8173
Mailing Address - Street 1:11750 SW BARNES RD STE 120
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5911
Mailing Address - Country:US
Mailing Address - Phone:503-646-5194
Mailing Address - Fax:503-646-9390
Practice Address - Street 1:11750 SW BARNES RD STE 120
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5911
Practice Address - Country:US
Practice Address - Phone:503-646-5194
Practice Address - Fax:503-646-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3134AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty