Healthcare Provider Details

I. General information

NPI: 1306077417
Provider Name (Legal Business Name): ELEANOR MUNOZ O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18750 WILLAMETTE DR STE C
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: 503-636-0144
Mailing address:
  • Phone: 971-732-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD60119602
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3330ATI
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: