Healthcare Provider Details

I. General information

NPI: 1962584441
Provider Name (Legal Business Name): CARKNER FAMILY VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 NORTH EAST 39TH AVENUE
PORTLAND OR
97212-5322
US

IV. Provider business mailing address

1775 NORTH EAST 39 TH AVENUE
PORTLAND OR
97212-5322
US

V. Phone/Fax

Practice location:
  • Phone: 503-288-6181
  • Fax: 503-288-7690
Mailing address:
  • Phone: 503-288-6181
  • Fax: 503-288-7690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEFFRY M CARKNER
Title or Position: OPTOMETRIST
Credential: O.D
Phone: 503-288-6181