Provider Demographics
NPI:1538345269
Name:APPLE EYECARE PC
Entity type:Organization
Organization Name:APPLE EYECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-962-7753
Mailing Address - Street 1:10709 WALTON ROAD
Mailing Address - Street 2:
Mailing Address - City:ISLAND CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97850
Mailing Address - Country:US
Mailing Address - Phone:541-962-7753
Mailing Address - Fax:541-963-0750
Practice Address - Street 1:10709 WALTON ROAD
Practice Address - Street 2:
Practice Address - City:ISLAND CITY
Practice Address - State:OR
Practice Address - Zip Code:97850
Practice Address - Country:US
Practice Address - Phone:541-962-7753
Practice Address - Fax:541-963-0750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4821750001Medicare NSC