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General NPI Number Information
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NPI Number | 1013182229
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Entity Type | Organization
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Legal Business Name | JANA L. MOUNTS O.D. INC.
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 2927 S.E. 73RD AVE
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City | HILLSBORO
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State | OR
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Zip | 97123
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Country | US
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Telephone | 503-591-0591
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Fax | 503-591-0511
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Provider Business Mailing Address
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Address Line | 1533 BONNIE LN
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City | FOREST GROVE
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State | OR
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Zip | 97116-2682
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JANA L. MOUNTS
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Credential | O.D.
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Telephone | 503-992-8562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 3113 AT
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License Number State | OR
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