Provider Demographics
NPI:1043969579
Name:SPECTRUM EYE CARE LLC
Entity type:Organization
Organization Name:SPECTRUM EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUNG
Authorized Official - Middle Name:K
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-698-2375
Mailing Address - Street 1:13180 SE 169TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-8727
Mailing Address - Country:US
Mailing Address - Phone:503-698-2375
Mailing Address - Fax:503-251-3761
Practice Address - Street 1:13180 SE 169TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-8727
Practice Address - Country:US
Practice Address - Phone:503-698-2375
Practice Address - Fax:503-251-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty