Healthcare Provider Details

I. General information

NPI: 1780972778
Provider Name (Legal Business Name): TIGARD VISION WORLD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9975 SW FREWING ST SUITE 130
TIGARD OR
97223-5091
US

IV. Provider business mailing address

9975 SW FREWING ST SUITE 130
TIGARD OR
97223-5091
US

V. Phone/Fax

Practice location:
  • Phone: 503-906-3596
  • Fax: 503-906-1014
Mailing address:
  • Phone: 503-906-3596
  • Fax: 503-906-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1863T
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY DONALD HARRIS
Title or Position: PRESIDENT
Credential: O.D.
Phone: 503-703-7451