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General NPI Number Information
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NPI Number | 1275664625
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Entity Type | Organization
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Legal Business Name | NEURO-OPHTHALMIC ASSOCIATES, LLC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1040 NW 22ND AVE SUITE 200
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City | PORTLAND
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State | OR
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Zip | 97210-3057
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Country | US
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Telephone | 503-413-8015
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Fax | 503-413-6937
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Provider Business Mailing Address
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Address Line | 1040 NW 22ND AVE SUITE 200
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City | PORTLAND
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State | OR
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Zip | 97210-3057
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Country | US
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Telephone | 503-413-8015
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Fax | 503-413-6937
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Authorized Official
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Title or Position | MEMBER-OWNER
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Name | DR. WILLIAM THOMAS SHULTS
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Credential | M.D.
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Telephone | 503-413-8032
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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 | MD07886
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License Number State | OR
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