Provider Demographics
NPI:1588748248
Name:OREGON HEALTH SCIENCES UNIVERSITY DEPARTMENT OF OPHTHALMOLOGY
Entity type:Organization
Organization Name:OREGON HEALTH SCIENCES UNIVERSITY DEPARTMENT OF OPHTHALMOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. ASSOC. DEAN, OHSU CLINICAL PRCT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASCIOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-494-5099
Mailing Address - Street 1:3375 SW TERWILLIGER BLVD
Mailing Address - Street 2:MAIL CODE CEI
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4146
Mailing Address - Country:US
Mailing Address - Phone:503-494-3000
Mailing Address - Fax:503-494-0470
Practice Address - Street 1:545 SW CAMPUS DR.
Practice Address - Street 2:SUITE 2531
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3130
Practice Address - Country:US
Practice Address - Phone:503-494-3000
Practice Address - Fax:503-494-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288024Medicaid
WA7107220Medicaid
OR3884840001Medicare NSC
OR288024Medicaid