Provider Demographics
NPI:1164458030
Name:CASEY EYE PHYSICIANS AND SURGEONS LLC
Entity type:Organization
Organization Name:CASEY EYE PHYSICIANS AND SURGEONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BETTIE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-494-8423
Mailing Address - Street 1:PO BOX 4183
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208
Mailing Address - Country:US
Mailing Address - Phone:360-514-9060
Mailing Address - Fax:360-514-9041
Practice Address - Street 1:3375 SW TERWILLINGER BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-6107
Practice Address - Fax:503-494-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH3727OtherRAILROAD MEDICARE
OR165392Medicaid
ORR120407Medicare PIN
WAG8807481Medicare PIN
ORR120411Medicare PIN
CH3727OtherRAILROAD MEDICARE
OR165392Medicaid
ORR120413Medicare PIN