Organization
PAULSON EYECARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE R PAULSON O.D. (OPTOMETRIST)
(541) 469-7775
Entity
Organization
Contact information
Practice address
586 5TH ST STE 300, BROOKINGS, OR 97415-9720
(541) 469-7775
Mailing address
586 5TH ST STE 300, BROOKINGS, OR 97415-9720
(541) 469-7775
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1359AT
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699887158
INDIVIDUAL NPI NUMBER
OR
05
—
236091
—
OR
Enumeration date
06/14/2007
Last updated
08/22/2020
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