Healthcare Provider Details

I. General information

NPI: 1558777664
Provider Name (Legal Business Name): BISANT LABIB O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2043 COLLEGE WAY BLDG 2221
FOREST GROVE OR
97116-1797
US

IV. Provider business mailing address

2043 COLLEGE WAY # A-134
FOREST GROVE OR
97116-1797
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-2020
  • Fax:
Mailing address:
  • Phone: 503-352-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4797AT
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002928
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: