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General NPI Number Information
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NPI Number | 1245101393
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Entity Type | Organization
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Legal Business Name | PORTLAND VISION LLC
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 1916 NE BROADWAY ST
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City | PORTLAND
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State | OR
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Zip | 97232-1502
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Country | US
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Telephone | 503-546-4193
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 SE LEXINGTON ST
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City | PORTLAND
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State | OR
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Zip | 97202-6364
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Country | US
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Telephone | 510-734-4567
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. SHAMIS FALLAH
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Credential | DO
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Telephone | 510-734-4567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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