Healthcare Provider Details

I. General information

NPI: 1699733758
Provider Name (Legal Business Name): GREG BROPHY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 NE DIVISION ST SUITE 101
GRESHAM OR
97030-5813
US

IV. Provider business mailing address

2150 NE DIVISION ST SUITE 101
GRESHAM OR
97030-5813
US

V. Phone/Fax

Practice location:
  • Phone: 503-667-2424
  • Fax: 503-492-3236
Mailing address:
  • Phone: 503-667-2424
  • Fax: 503-492-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1890T
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: