Organization
EYECARE CENTER OF SALEM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL BISHOP OD (MEMBER)
(503) 364-0512
Entity
Organization
Contact information
Practice address
660 CAPITOL ST NE, SALEM, OR 97301
(503) 364-0512
(503) 588-7108
Mailing address
1415 CAPITOL ST NE, SALEM, OR 97301-2504
(503) 364-0512
(503) 588-7108
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1472ATI
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0434300001
CIGNA MEDICARE
OR
05
—
11376-1
—
OR
01
—
1472ATI
LICENSE
OR
01
—
807522000
BLUE CROSS BLUE SHIELD
OR
01
—
T67431
UPIN
OR
Enumeration date
03/21/2007
Last updated
09/03/2019
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