Healthcare Provider Details

I. General information

NPI: 1396400313
Provider Name (Legal Business Name): OPTOMETRIC CARE OF OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22640 SE STARK ST
GRESHAM OR
97030-2684
US

IV. Provider business mailing address

3333 QUALITY DR
RANCHO CORDOVA CA
95670-7985
US

V. Phone/Fax

Practice location:
  • Phone: 503-667-0441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: STEVE JUNG
Title or Position: OWNER
Credential: OD
Phone: 541-338-4844