Organization
ELEMENTAL EYECARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GABRIELLE WARREN MARSHALL O.D. (OWNER)
(541) 323-3937
Entity
Organization
Contact information
Practice address
2736 NW CROSSING DR, SUITE 120, BEND, OR 97701
(541) 323-3937
(541) 323-3938
Mailing address
2736 NW CROSSING DR, SUITE 120, BEND, OR 97701-7180
(541) 323-3937
(541) 323-3938
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2635 ATI
OR
152WP0200X
Pediatric Optometrist
2635 ATI
OR
152WV0400X
Vision Therapy Optometrist
2635 ATI
OR
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
04/06/2009
Last updated
08/15/2018
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