Organization
LIGHTHOUSE VISION CARE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND K DEHAAN O.D. (OPTOMETRIST/PRESIDENT)
(503) 842-6363
Entity
Organization
Contact information
Practice address
310 STILLWELL AVE, TILLAMOOK, OR 97141-2119
(503) 842-6363
(503) 842-6204
Mailing address
310 STILLWELL AVE, TILLAMOOK, OR 97141-2119
(503) 842-6363
(503) 842-6204
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2858T
OR
152WC0802X
Corneal and Contact Management Optometrist
2858T
OR
152WP0200X
Pediatric Optometrist
2858T
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182762
—
OR
Enumeration date
09/24/2007
Last updated
09/24/2007
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