PAM EBERT OD LLC (NPI# 1750650131) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750650131 |
| Entity Type | Organization |
| Organization Name | PAM EBERT OD LLC |
| Other Organization Name | CUSTOM EYES |
| Practice Address |
1871 2nd St Springfield OR 97477-2121 |
| Practice Telephone | 5417410122 |
| Mailing Telephone | 5417410122 |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2015-06-29 |
| Authorized Official Name | DR. PAM EBERT (OWNER) |
| Authorized Official Telephone | 5417410122 |
| Authorized Official Credential | OD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | 3484AT | OR | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | PTAN | R174133 | 01 |
| Other Name | Type Code |
|---|---|
| Custom Eyes | Doing Business As Name - Organization |
| Street Address |
1871 2ND ST |
| City | SPRINGFIELD |
| State | OR |
| Zip Code | 97477-2121 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124155528 | Pam Ebert | Optometrist | 1871 2nd St, Springfield, OR 97477-2121 | 2007-02-27 |
| 1144556655 | Joanna M Gervais Od LLC | Eyewear Supplier (Equipment, not the service) | 1871 2nd St, Springfield, OR 97477-2121 | 2009-10-19 |
| 1780845610 | Joanna M Gervais | Optometrist | 1871 2nd St, Springfield, OR 97477-2121 | 2008-06-23 |
| 1770615205 | Gerald Lee Cates | Optometrist | 1871 2nd St, Springfield, OR 97477-2121 | 2007-03-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508416140 | Chase Michael Collings | Physician Assistant | 960 N 16th St Ste 303, Springfield, OR 97477 | 2019-09-16 |
| 1174079396 | Amie Flanagan | Occupational Therapy Assistant | 3152 Valentine Court, Springfield, OR 97477 | 2016-08-28 |
| 1609229590 | Kiernan Davis Snedigar | Counselor | 175 W B St Ste J, Springfield, OR 97477 | 2016-07-15 |
| 1578914206 | Ryan James Dixon | Counselor | 1923 Centennial Blvd, Springfield, OR 97477 | 2016-06-23 |
| 1902275464 | Jovonnie Bashaw | Counselor | 1157 5th St, Springfield, OR 97477 | 2015-09-15 |
| 1053759506 | Norco Inc | Durable Medical Equipment & Medical Supplies | 302 Shelley St Ste 7&8, Springfield, OR 97477 | 2013-06-06 |
| 1780931634 | Justin Morris | Pharmacist | 1891 Pioneer Parkway East, Springfield, OR 97477 | 2012-08-09 |
| 1194083105 | Mersedeh Bahr Hosseini | Psychiatry & Neurology | 3311 Riverbend Dr., Neurohospitalists, Springfield, OR 97477 | 2012-04-26 |
| 1962769679 | Hiro Kawata | Internal Medicine | 3311 Rierbend Dr., Springfield, OR 97477 | 2012-04-19 |
| 1659662823 | Wendy A Teigen | Counselor | 3995 Marcola Rd., Springfield, OR 97477 | 2011-04-22 |
| Find all providers in zip 97477 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
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| 1265046700 | Guan Yuan Pllc | Clinic/Center | 7008 Catlett St, Springfield, VA 22151-3901 | 2020-09-02 |
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| 1922414846 | Planned Parenthood of Illinois | Clinic/Center | 1000 E. Washington St., Springfield, IL 62703-1048 | 2014-07-11 |
| 1841537966 | Village Family Medicine, LLC | Clinic/Center | 31330 Highway 22, Suite 101, Springfield, LA 70462-7427 | 2013-01-09 |
| 1770868457 | Walgreens Pharmacy #12427 | Clinic/Center | 2305 W Monroe, Springfield, IL 62704 | 2011-10-13 |
| 1194023044 | Hungry Hill Family Practice | Clinic/Center | 776 Liberty Street, Hungry Hill Family Practice, Springfield, MA 01104 | 2011-03-02 |
| 1356643498 | Medical Necessities Inc | Clinic/Center | 205 5th Ave E, Springfield, TN 37172-2435 | 2010-11-22 |
| 1003124587 | James M. Carmichael, Dc PC | Clinic/Center | 3108 S Fremont Ave, Springfield, MO 65804-4211 | 2010-09-19 |
| 1114231305 | Imaging Miracles Lc | Clinic/Center | 3827 S Timbercreek Ave, Suite B, Springfield, MO 65807-5685 | 2010-07-30 |
| 1174793855 | American Current Care of Massachusetts PC | Clinic/Center | 140 Carando Road, Springfield, MA 01104-3296 | 2008-03-10 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 97477 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.