Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1709ATI | OR |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1709ATI | OR |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 1709ATI | OR |
N | 152WP0200X | Pediatric Optomitrist | 1709ATI | OR |
N | 152WS0006X | Sports Vision | 1709ATI | OR |
N | 152WV0400X | Optomitrist - Vision Therapist | 1709ATI | OR |
N | 152WX0102X | Occupational Vision | 1709ATI | OR |
NPI | 1104952910 |
---|---|
Provider Name | Dr. William Ray Losie |
First Address | Eugene, OR 97402-3655 |
Second Address | Eugene, OR 97402-3655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 07/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
108225 | (05) | OR |
931295758 | VISION SERVICE PLAN (01) | OR |
T76653 | (02) | OR |