Healthcare Provider Details

I. General information

NPI: 1891742722
Provider Name (Legal Business Name): JOHN MICHAEL BOYER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 SW BOND AVE
PORTLAND OR
97239-4501
US

IV. Provider business mailing address

2241 LLOYD CTR
PORTLAND OR
97232-1315
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-3098
  • Fax: 503-418-9112
Mailing address:
  • Phone: 503-494-6107
  • Fax: 503-494-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOR 1265 ATI
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: