Healthcare Provider Details

I. General information

NPI: 1174140610
Provider Name (Legal Business Name): ELEANOR MUNOZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18750 WILLAMETTE DR
WEST LINN OR
97068-1700
US

IV. Provider business mailing address

7005 SW ALGONKIN ST
TUALATIN OR
97062-9212
US

V. Phone/Fax

Practice location:
  • Phone: 503-697-8879
  • Fax: 503-650-5357
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ELEANOR MUNOZ
Title or Position: OWNER
Credential: OD
Phone: 971-732-9494