| NPI | 1003215807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEIRSTEN DANEE EAGLES Owner 503-881-5486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 3228ATI) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: OR 3228ATI) |
| 152WS0006X Optometrist, Sports Vision (Licence: OR 3228ATI) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: OR 3228ATI) | |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2014-08-18 |