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General NPI Number Information
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NPI Number | 1205924206
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Entity Type | Organization
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Legal Business Name | THE SPECTOR GROUP, INC.
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 02/28/2014
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Provider Practice Location Address
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Address Line | 226 E HISTORIC COLUMBIA RIVER HWY
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City | TROUTDALE
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State | OR
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Zip | 97060-2069
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Country | US
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Telephone | 503-492-3897
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Fax | 503-665-4137
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Provider Business Mailing Address
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Address Line | 226 E HISTORIC COLUMBIA RIVER HWY
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City | TROUTDALE
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State | OR
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Zip | 97060-2069
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Country | US
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Telephone | 503-492-3897
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Fax | 503-665-4137
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Authorized Official
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Title or Position | CORPORATE PRESIDENT
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Name | DR. JAMES MICHAEL GURTISEN
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Credential | OD
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Telephone | 503-492-3897
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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 | 2320T
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License Number State | OR
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