Healthcare Provider Details

I. General information

NPI: 1699973180
Provider Name (Legal Business Name): NEWBERG VISION CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 PORTLAND RD STE A
NEWBERG OR
97132-1371
US

IV. Provider business mailing address

2207 PORTLAND RD STE A
NEWBERG OR
97132-1371
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-3277
  • Fax:
Mailing address:
  • Phone: 503-538-3277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3200ATI
License Number StateOR

VIII. Authorized Official

Name: DR. PAULA A TAYLOR
Title or Position: SECRETARY TREASURER
Credential: O.D.
Phone: 503-487-7658