Provider Demographics
NPI:1053523068
Name:BEND OPHTHALMOLOGY
Entity type:Organization
Organization Name:BEND OPHTHALMOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:X
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-389-3166
Mailing Address - Street 1:2275 NE DOCTORS DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6092
Mailing Address - Country:US
Mailing Address - Phone:541-389-3166
Mailing Address - Fax:541-383-1338
Practice Address - Street 1:2275 NE DOCTORS DR
Practice Address - Street 2:SUITE 6
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6092
Practice Address - Country:US
Practice Address - Phone:541-389-3166
Practice Address - Fax:541-383-1338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCI3572OtherRAILROAD MEDICARE
OR0487470001Medicare NSC
ORCI3572OtherRAILROAD MEDICARE