Healthcare Provider Details

I. General information

NPI: 1700833209
Provider Name (Legal Business Name): KIRK PARKER OD P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 SW MARLOW AVE
PORTLAND OR
97225-5101
US

IV. Provider business mailing address

1517 SW MARLOW AVE
PORTLAND OR
97225-5101
US

V. Phone/Fax

Practice location:
  • Phone: 503-292-5221
  • Fax: 503-297-3937
Mailing address:
  • Phone: 503-292-5221
  • Fax: 503-297-3937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. KIRK J PARKER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 503-292-5221