MEDICARE: DR. CAROLINE MARIE OOLEY 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
1	152W00000X	Optometrist	3496ATI	OR

General Provider Information

NPI Number	:	1902245574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLINE MARIE OOLEY O.D.

Provider Business Mailing Address
First Line	:	10510 SW BUTNER RD APT 2
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-5236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10510 SW BUTNER RD APT 2
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-5236
Country	:	US
Telephone Number	:	858-401-2100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	06/17/2013

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