NPI 1679253397 · live from the CMS NPI Registry
Aeg Oregon Professional LLC
Optometrist in Salem, OR. National Provider Identifier 1679253397, active.
NPI record
| NPI | 1679253397 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 990 Broadway St Ne Ste 100, Salem, OR 97301 |
| Practice phone | 503-364-0767 |
| Mailing address | 111 E 4th St Ste 440, Alton, IL 62002 |
| Enumerated | July 18, 2023 |
| Last updated | June 20, 2024 |
| Authorized official | Melissa Allison, Sr. Director Rcm/Mvc |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist primary | 152W00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.