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General NPI Number Information
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NPI Number | 1134204159
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Entity Type | Individual
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Provider Name | JOHN BERNARD KREBSBACH O. D.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 518 SE OAK ST STE 2020
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City | HILLSBORO
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State | OR
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Zip | 97123-4896
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Country | US
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Telephone | 503-648-2020
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Fax | 503-648-0868
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Provider Business Mailing Address
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Address Line | 2930 WATERCREST RD
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City | FOREST GROVE
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State | OR
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Zip | 97116-1034
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Country | US
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Telephone | 503-357-5390
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1571ATI
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License Number State | OR
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