Healthcare Provider Details

I. General information

NPI: 1851060420
Provider Name (Legal Business Name): SHAUNTEL STEELE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15901 SW JENKINS RD
ALOHA OR
97006-5045
US

IV. Provider business mailing address

1714 DOUGLAS ST APT 1
FOREST GROVE OR
97116-4201
US

V. Phone/Fax

Practice location:
  • Phone: 503-641-6023
  • Fax:
Mailing address:
  • Phone: 360-903-3698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberATI4599
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: