Provider Demographics
NPI:1992870604
Name:RAINBOW OPTICS, PC
Entity type:Organization
Organization Name:RAINBOW OPTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DECALESTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-343-5555
Mailing Address - Street 1:1740 W 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3625
Mailing Address - Country:US
Mailing Address - Phone:541-343-5555
Mailing Address - Fax:
Practice Address - Street 1:1740 W 18TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3625
Practice Address - Country:US
Practice Address - Phone:541-343-5555
Practice Address - Fax:541-334-7605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WCJVNOtherMEDICARE GROUP
ORR0000WCJVNOtherMEDICARE GROUP