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General NPI Number Information
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NPI Number | 1144847260
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Entity Type | Organization
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Legal Business Name | PARKROSE VISION, LLC
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Dates
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Enumeration Date | 07/06/2020
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 4880 NE 104TH AVE
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City | PORTLAND
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State | OR
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Zip | 97220
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Country | US
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Telephone | 503-943-0699
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Fax |
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Provider Business Mailing Address
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Address Line | 15470 SE BADEN POWELL RD
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-6049
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Country | US
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Telephone | 503-819-1807
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Fax | 503-432-8402
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Authorized Official
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Title or Position | OWNER
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Name | HALEY KIM
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Credential | OD
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Telephone | 503-432-8452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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