Healthcare Provider Details

I. General information

NPI: 1629046818
Provider Name (Legal Business Name): JEFFREY DONALD HARRIS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11020 SW BEAVERTON HILLSDALE HWY
BEAVERTON OR
97005-3007
US

IV. Provider business mailing address

9975SWFREWING ST 130
TIGARD OR
97223-5091
US

V. Phone/Fax

Practice location:
  • Phone: 503-526-9697
  • Fax: 503-644-8330
Mailing address:
  • Phone: 503-906-3596
  • Fax: 503-906-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT11820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: