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NPI Code Detail

MEDICARE: BISANT LABIB O.D.

MEDICARE: BISANT LABIB O.D.
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
1152W00000XOptometrist4797ATOR
2152W00000XOptometristOEG002928PA

General Provider Information

NPI Number : 1558777664
Entity Type Code : Individual
Provider Name (Legal Business Name) : BISANT LABIB O.D.
Provider Business Mailing Address
First Line : 2043 COLLEGE WAY # A-134
Second Line :
City : FOREST GROVE
State : OR
Zip : 97116-1797
Country : US
Telephone Number : 503-352-2020
Fax Number :
Provider Business Practice Location Address
First Line : 2043 COLLEGE WAY BLDG 2221
Second Line :
City : FOREST GROVE
State : OR
Zip : 97116-1797
Country : US
Telephone Number : 503-352-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2014
Last Update Date : 12/12/2025

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