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General NPI Number Information
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NPI Number | 1376162008
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Entity Type | Organization
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Legal Business Name | EYESTRONG, LLC
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 3934 NE MLK JR BLVD STE 101
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City | PORTLAND
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State | OR
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Zip | 97212-1153
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Country | US
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Telephone | 503-384-2489
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Fax |
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Provider Business Mailing Address
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Address Line | 3934 NE MLK JR BLVD STE 101
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City | PORTLAND
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State | OR
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Zip | 97212-1153
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OD
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Name | LAURA MAE ARMSTRONG
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Credential | OD
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Telephone | 503-762-1080
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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Taxonomy #4
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number |
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License Number State |
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