MEDICARE: LAKE OSWEGO VISION CLINIC 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	1115355-6	OR

General Provider Information

NPI Number	:	1750506937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE OSWEGO VISION CLINIC LLC

Provider Business Mailing Address
First Line	:	15480 BOONES FERRY RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-3429
Country	:	US
Telephone Number	:	503-635-1458
Fax Number	:

Provider Business Practice Location Address
First Line	:	15480 BOONES FERRY RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-3429
Country	:	US
Telephone Number	:	503-635-1458
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TODD MICHAEL SHELDON
Credential	:
Telephone Number	:	541-548-2488

Provider Enumeration Date	:	04/14/2007
Last Update Date	:	07/10/2025

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Directions to “LAKE OSWEGO VISION CLINIC LLC ” Practice Location

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