# EYE HEALTH EASTSIDE SURGERY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750362869
- **Authorized official:** BRETT WILLIAMS (CEO)
- **Authorized official phone:** (503) 344-5101

## Contact information

- **Practice address:** 12050 SE STEVENS RD STE 400, PORTLAND, OR 97086-7667
- **Practice address phone:** (971) 206-6100
- **Practice address fax:** (971) 206-6103
- **Mailing address:** PO BOX 220059, MILWAUKIE, OR 97269-0059
- **Mailing address phone:** (503) 558-7372
- **Mailing address fax:** (503) 344-5140

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 07-1553 | OR | Yes |
| 261QS0132X | Ophthalmologic Surgery Clinic/Center | 07-1553 | OR | — |

## Other

- **Enumeration date:** 11/07/2005
- **Last updated:** 04/05/2022