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General NPI Number Information
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NPI Number | 1083994867
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Entity Type | Organization
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Legal Business Name | CENTER FOR OCULAR PROSTHETICS LLC
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 2456 NW NORTHRUP ST STE 1A
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City | PORTLAND
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State | OR
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Zip | 97210-3253
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Country | US
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Telephone | 503-229-8490
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Fax | 503-224-0740
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Provider Business Mailing Address
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Address Line | 2456 NW NORTHRUP ST STE 1A
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City | PORTLAND
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State | OR
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Zip | 97210-3253
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Country | US
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Telephone | 503-229-8490
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Fax | 503-224-0740
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Authorized Official
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Title or Position | OCULARIST/OWNER
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Name | CHRISTINA N. LEITZEL
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Credential | BS, BCO, BADO
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Telephone | 503-229-8490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 51680289
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 516802-89
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 156FX1700X
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Taxonomy Name | Ocularist
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License Number |
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License Number State |
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