Healthcare Provider Details

I. General information

NPI: 1639243652
Provider Name (Legal Business Name): SUNSET VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S 1ST AVE SUITE-A
HILLSBORO OR
97123-3902
US

IV. Provider business mailing address

333 S 1ST AVE SUITE-A
HILLSBORO OR
97123-3902
US

V. Phone/Fax

Practice location:
  • Phone: 503-357-8454
  • Fax: 503-357-8465
Mailing address:
  • Phone: 503-357-8454
  • Fax: 503-357-8465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNY BENJAMIN LEE
Title or Position: PARTNER
Credential: O.D
Phone: 503-357-8454