Provider Demographics
NPI:1053439588
Name:NORTHWEST OPTOMETRIC CLINICS, INC.
Entity type:Organization
Organization Name:NORTHWEST OPTOMETRIC CLINICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:S
Authorized Official - Last Name:FREEDLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-693-8844
Mailing Address - Street 1:7307 SW BEVELAND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8609
Mailing Address - Country:US
Mailing Address - Phone:503-639-8844
Mailing Address - Fax:503-639-1904
Practice Address - Street 1:7307 SW BEVELAND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8609
Practice Address - Country:US
Practice Address - Phone:503-639-8844
Practice Address - Fax:503-639-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR121563Medicare PIN