Healthcare Provider Details

I. General information

NPI: 1245556687
Provider Name (Legal Business Name): CARKNERS FAMILY VISION CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 NE CESAR E CHAVEZ BLVD
PORTLAND OR
97212-5322
US

IV. Provider business mailing address

1775 NE CESAR E CHAVEZ BLVD
PORTLAND OR
97212-5322
US

V. Phone/Fax

Practice location:
  • Phone: 503-288-6181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1137ATI
License Number StateOR

VIII. Authorized Official

Name: DR. DAVID C CARKNER
Title or Position: OWNER/PARTNER
Credential: OD
Phone: 503-692-2020