MEDICARE: CHRISTINE R GEBHARDT OD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2571T	OR

General Provider Information

NPI Number	:	1457387110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTINE R GEBHARDT OD LLC

Provider Business Mailing Address
First Line	:	5935 SE DIVISION ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-1470
Country	:	US
Telephone Number	:	503-777-5546
Fax Number	:	971-255-1764

Provider Business Practice Location Address
First Line	:	5935 SE DIVISION ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-1470
Country	:	US
Telephone Number	:	503-777-5546
Fax Number	:	971-255-1764

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. CHRISTINE RENE GEBHARDT
Credential	:	O.D.
Telephone Number	:	503-777-5546

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	06/10/2014

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