| Custom Eyes | |
|
1871 2nd St Springfield OR 97477-2121 | |
| (541) 741-0122 | |
| Not Available |
| Full Name | Custom Eyes |
|---|---|
| Speciality | Clinic/center |
| Location | 1871 2nd St, Springfield, Oregon |
| Authorized Official Name and Position | Pam Ebert (OWNER) |
| Authorized Official Contact | 5417410122 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Custom Eyes 1871 2nd St Springfield OR 97477-2121 Ph: (541) 741-0122 | Custom Eyes 1871 2nd St Springfield OR 97477-2121 Ph: (541) 741-0122 |
| NPI Number | 1750650131 |
|---|---|
| Provider Enumeration Date | 12/14/2011 |
| Last Update Date | 06/29/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750650131 | NPI | - | NPPES |
| R174133 | Other | OR | PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 3484AT (Oregon) | Primary |
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