Healthcare Provider Details

I. General information

NPI: 1245918580
Provider Name (Legal Business Name): RACHEL HOPE BLAKEMORE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL HOPE ELLIS

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 SW SUNSET BLVD
PORTLAND OR
97239-2626
US

IV. Provider business mailing address

1522 SW SUNSET BLVD
PORTLAND OR
97239-2626
US

V. Phone/Fax

Practice location:
  • Phone: 503-473-8039
  • Fax: 503-473-8952
Mailing address:
  • Phone: 503-473-8039
  • Fax: 503-473-8952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberATI4695
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: