# EYE HEALTH NORTHWEST P.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** EYE HEALTH NORTHWEST P.C.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1124353362
- **Legal business name:** EYE HEALTH NORTHWEST P.C.
- **Authorized official:** DR. SHANE K KIM M.D. (PRESIDENT)
- **Authorized official phone:** (503) 255-2291

## Contact information

- **Practice address:** 11086 SE OAK ST, MILWAUKIE, OR 97222-6692
- **Practice address phone:** (503) 656-4221
- **Practice address fax:** (503) 656-4249
- **Mailing address:** PO BOX 22009, MILWAUKIE, OR 97269-2009
- **Mailing address phone:** (503) 558-7372
- **Mailing address fax:** (503) 344-5110

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/06/2009
- **Last updated:** 02/20/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 085006 | — | OR |