Healthcare Provider Details

I. General information

NPI: 1508818832
Provider Name (Legal Business Name): JULIE FALARDEAU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 SW BOND AVE FL 11
PORTLAND OR
97239-4501
US

IV. Provider business mailing address

3303 SW BOND AVE
PORTLAND OR
97239-4501
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-5268
  • Fax: 503-494-3017
Mailing address:
  • Phone: 503-494-3687
  • Fax: 503-494-3017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD25375
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License NumberMD25375
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: