Provider Demographics
NPI:1386962173
Name:OREGON RETINA, LLC
Entity type:Organization
Organization Name:OREGON RETINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-762-2763
Mailing Address - Street 1:1550 OAK STREET
Mailing Address - Street 2:SUITE #4
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4895
Mailing Address - Country:US
Mailing Address - Phone:541-762-2763
Mailing Address - Fax:
Practice Address - Street 1:775 SW 9TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4895
Practice Address - Country:US
Practice Address - Phone:541-762-2763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R150076Medicare PIN