Healthcare Provider Details

I. General information

NPI: 1801873310
Provider Name (Legal Business Name): CHRISTINE RENE GEBHARDT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 02/20/2021
Certification Date: 02/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5935 SE DIVISION ST
PORTLAND OR
97206-1470
US

IV. Provider business mailing address

PO BOX 22009
MILWAUKIE OR
97269-2009
US

V. Phone/Fax

Practice location:
  • Phone: 503-777-5546
  • Fax: 971-255-1764
Mailing address:
  • Phone: 503-558-7372
  • Fax: 503-344-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2571T
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: