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General NPI Number Information
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NPI Number | 1134480544
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Entity Type | Organization
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Legal Business Name | FORBES OPTICAL PC
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 2020 8TH AVE STE A
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City | WEST LINN
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State | OR
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Zip | 97068-4657
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Country | US
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Telephone | 503-652-1479
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 8TH AVE STE A
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City | WEST LINN
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State | OR
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Zip | 97068-4657
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Country | US
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Telephone | 503-652-1479
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | DR. ROBERT D FORBES
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Credential | OD
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Telephone | 503-652-1479
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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 | 3003ATI
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License Number State | OR
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