Healthcare Provider Details

I. General information

NPI: 1356902209
Provider Name (Legal Business Name): MASHA L MOLODYH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MASHA CHEUNG

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30020 SW BOONES FERRY RD STE 10
WILSONVILLE OR
97070-8912
US

IV. Provider business mailing address

307 MONITOR RD
SILVERTON OR
97381-1212
US

V. Phone/Fax

Practice location:
  • Phone: 503-570-0963
  • Fax:
Mailing address:
  • Phone: 503-910-5528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4445ATI
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: