Healthcare Provider Details

I. General information

NPI: 1356382006
Provider Name (Legal Business Name): HANSINI PRASAD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18345 SW ALEXANDER ST STE A
ALOHA OR
97003-3960
US

IV. Provider business mailing address

PO BOX 22009
PORTLAND OR
97269-2009
US

V. Phone/Fax

Practice location:
  • Phone: 503-642-2505
  • Fax:
Mailing address:
  • Phone: 503-558-7372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberAT3128
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: