Healthcare Provider Details

I. General information

NPI: 1669500278
Provider Name (Legal Business Name): JILL SCHEIFFELE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 NE 102ND AVE
PORTLAND OR
97220-3902
US

IV. Provider business mailing address

1111 NE 102ND AVE
PORTLAND OR
97220-3902
US

V. Phone/Fax

Practice location:
  • Phone: 503-255-7782
  • Fax: 503-255-7787
Mailing address:
  • Phone: 503-255-7782
  • Fax: 503-255-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number3117AT
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: