Organization
PAM EBERT OD LLC
Active
Other names
Custom Eyes
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAM EBERT OD (OWNER)
(541) 741-0122
Entity
Organization
Contact information
Practice address
1871 2ND ST, SPRINGFIELD, OR 97477-2121
(541) 741-0122
Mailing address
1871 2ND ST, SPRINGFIELD, OR 97477-2121
(541) 741-0122
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
3484AT
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R174133
PTAN
OR
Enumeration date
12/14/2011
Last updated
06/29/2015
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