Healthcare Provider Details

I. General information

NPI: 1427060714
Provider Name (Legal Business Name): MARI WARD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. MARI WARD HESTER

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20661 SW ROY ROGERS RD STE 503
SHERWOOD OR
97140-9277
US

IV. Provider business mailing address

20661 SW ROY ROGERS RD STE 503
SHERWOOD OR
97140-9277
US

V. Phone/Fax

Practice location:
  • Phone: 503-635-5599
  • Fax: 503-625-5992
Mailing address:
  • Phone: 503-635-5599
  • Fax: 503-625-5992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3023ATI
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: