Healthcare Provider Details

I. General information

NPI: 1083994867
Provider Name (Legal Business Name): CENTER FOR OCULAR PROSTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2456 NW NORTHRUP ST STE 1A
PORTLAND OR
97210-3253
US

IV. Provider business mailing address

2456 NW NORTHRUP ST STE 1A
PORTLAND OR
97210-3253
US

V. Phone/Fax

Practice location:
  • Phone: 503-229-8490
  • Fax: 503-224-0740
Mailing address:
  • Phone: 503-229-8490
  • Fax: 503-224-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number51680289
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number516802-89
License Number StateOR

VIII. Authorized Official

Name: CHRISTINA N. LEITZEL
Title or Position: OCULARIST/OWNER
Credential: BS, BCO, BADO
Phone: 503-229-8490