=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164587754
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEAL JAMES GARHOFER OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2006
-----------------------------------------------------
Last Update Date | 01/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 695 S HIGHWAY 101
-----------------------------------------------------
City | WARRENTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97146-9319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-861-9829
-----------------------------------------------------
Fax | 503-861-9830
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 695 S HIGHWAY 101
-----------------------------------------------------
City | WARRENTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97146-9319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 150-371-7247
-----------------------------------------------------
Fax | 503-861-9830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2199T
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------