Provider Demographics
NPI:1528050523
Name:DESCHUTES EYE CLINIC PC
Entity type:Organization
Organization Name:DESCHUTES EYE CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLI
Authorized Official - Middle Name:I
Authorized Official - Last Name:TRAUSTASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-548-7170
Mailing Address - Street 1:813 SW HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-3123
Mailing Address - Country:US
Mailing Address - Phone:541-548-7170
Mailing Address - Fax:541-548-3842
Practice Address - Street 1:813 SW HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-3123
Practice Address - Country:US
Practice Address - Phone:541-548-7170
Practice Address - Fax:541-548-3842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR053857000OtherREGENCE BCBS
ORCJ8770OtherRAILROAD MEDICARE
OR38080AOtherCLEAR CHOICE
OR053857000OtherREGENCE BCBS