Healthcare Provider Details

I. General information

NPI: 1275647000
Provider Name (Legal Business Name): JOSEPH NERON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15480 BOONES FERRY RD
LAKE OSWEGO OR
97035-3429
US

IV. Provider business mailing address

226 E HISTORIC COLUMBIA RIVER HWY
TROUTDALE OR
97060-2069
US

V. Phone/Fax

Practice location:
  • Phone: 503-635-1458
  • Fax: 503-635-0162
Mailing address:
  • Phone: 503-492-3897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3169ATI
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: