Healthcare Provider Details

I. General information

NPI: 1518302918
Provider Name (Legal Business Name): CASCADE VISION CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SE 223RD AVE SUITE 160
GRESHAM OR
97030-2574
US

IV. Provider business mailing address

1201 SE 223RD AVE STE 160
GRESHAM OR
97030-2577
US

V. Phone/Fax

Practice location:
  • Phone: 503-492-2020
  • Fax: 503-465-6825
Mailing address:
  • Phone: 503-492-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1647T
License Number StateOR

VIII. Authorized Official

Name: DR. MEL G. MACPHEE
Title or Position: OPTOMETRIST
Credential: D.O.
Phone: 503-492-2020