Healthcare Provider Details

I. General information

NPI: 1861402570
Provider Name (Legal Business Name): BOBIN KAY MONT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 NW 185TH AVE
HILLSBORO OR
97124-7073
US

IV. Provider business mailing address

741 NW JACKSON ST
HILLSBORO OR
97124-3703
US

V. Phone/Fax

Practice location:
  • Phone: 503-690-9200
  • Fax:
Mailing address:
  • Phone: 503-693-2980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2679ATI
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: