Healthcare Provider Details

I. General information

NPI: 1992699540
Provider Name (Legal Business Name): ISABEL LEEDS GROTH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MONROE PKWY STE 160
LAKE OSWEGO OR
97035-8863
US

IV. Provider business mailing address

9 MONROE PKWY STE 160
LAKE OSWEGO OR
97035-8863
US

V. Phone/Fax

Practice location:
  • Phone: 503-636-2551
  • Fax: 503-636-3055
Mailing address:
  • Phone: 503-636-2551
  • Fax: 503-636-3055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4816
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: