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General NPI Number Information
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NPI Number | 1215111901
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Entity Type | Organization
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Legal Business Name | HENRY FRANK STOREY OD
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 05/20/2011
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Provider Practice Location Address
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Address Line | 515 N 3RD AVE
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City | STAYTON
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State | OR
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Zip | 97383-1729
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Country | US
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Telephone | 503-769-3441
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Fax | 503-769-1419
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Provider Business Mailing Address
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Address Line | 515 N 3RD AVE
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City | STAYTON
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State | OR
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Zip | 97383-1729
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Country | US
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Telephone | 503-769-3441
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Fax | 503-769-1419
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Authorized Official
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Title or Position | OWNER
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Name | DR. HENRY FRANK STOREY
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Credential | O.D.
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Telephone | 503-769-3441
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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 | 1174ATI
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License Number State | OR
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