Healthcare Provider Details

I. General information

NPI: 1295947745
Provider Name (Legal Business Name): STEVEN DEAN PORTER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STEVEN DEAN PORTER O.D.

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 NE 138TH AVE
PORTLAND OR
97230-3401
US

IV. Provider business mailing address

302 E SHERIDAN ST
NEWBERG OR
97132-2724
US

V. Phone/Fax

Practice location:
  • Phone: 503-256-7940
  • Fax: 503-256-7940
Mailing address:
  • Phone: 503-256-7940
  • Fax: 503-256-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1723T
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: