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General NPI Number Information
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NPI Number | 1184323255
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Entity Type | Organization
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Legal Business Name | PALMER EYE CARE, LLC
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 17510 PROVOST ST STE 103
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-5199
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Country | US
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Telephone | 971-356-0848
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Fax | 971-356-0850
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Provider Business Mailing Address
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Address Line | 17510 PROVOST ST STE 103
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-5199
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Country | US
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Telephone | 971-356-0848
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Fax | 971-356-0850
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. KYLE J PALMER
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Credential | OD
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Telephone | 503-312-6114
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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 |
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License Number State |
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