Provider Demographics
NPI:1487786455
Name:VISION PENDLETON, LLC
Entity type:Organization
Organization Name:VISION PENDLETON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MONKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-276-3653
Mailing Address - Street 1:1815 SW EMIGRANT AVE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-1843
Mailing Address - Country:US
Mailing Address - Phone:541-276-3653
Mailing Address - Fax:541-966-4322
Practice Address - Street 1:1815 SW EMIGRANT AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-1843
Practice Address - Country:US
Practice Address - Phone:541-276-3653
Practice Address - Fax:541-966-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2456ATI152W00000X
OR2399ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR106856Medicare ID - Type Unspecified