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General NPI Number Information
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NPI Number | 1275628869
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Entity Type | Organization
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Legal Business Name | HILLSBORO EYE CLINIC, PC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 18650 NW CORNELL RD SUITE 112
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City | HILLSBORO
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State | OR
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Zip | 97124-9208
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Country | US
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Telephone | 503-645-8808
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Fax | 503-693-0441
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Provider Business Mailing Address
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Address Line | 512 E MAIN ST
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City | HILLSBORO
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State | OR
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Zip | 97123-9208
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Country | US
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Telephone | 503-640-3708
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Fax | 503-693-0441
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY L GARD
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Credential | MD
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Telephone | 503-640-3708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | OR
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