Healthcare Provider Details

I. General information

NPI: 1902894520
Provider Name (Legal Business Name): KAREN M RICE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN M GAST D.O.

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 NW LOVEJOY ST SUITE 100
PORTLAND OR
97210-2859
US

IV. Provider business mailing address

4311 SE 49TH AVE
PORTLAND OR
97206-4067
US

V. Phone/Fax

Practice location:
  • Phone: 503-274-2121
  • Fax:
Mailing address:
  • Phone: 503-229-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number2903T
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: