Healthcare Provider Details

I. General information

NPI: 1407801756
Provider Name (Legal Business Name): LORNA ELIZABETH EDMUNDS MD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 SW BOND AVE 11TH FLOOR
PORTLAND OR
97239-4501
US

IV. Provider business mailing address

3303 SW BOND AVE 11TH FLOOR
PORTLAND OR
97239-4501
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-2266
  • Fax: 503-418-9375
Mailing address:
  • Phone: 503-494-3000
  • Fax: 503-418-0834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberLL14890
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberMD126332
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: