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General NPI Number Information
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NPI Number | 1376680454
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Entity Type | Organization
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Legal Business Name | OSWEGO OPTIQUE INC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/31/2015
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Provider Practice Location Address
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Address Line | 466 2ND ST
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-3127
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Country | US
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Telephone | 503-636-6900
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Fax | 503-636-2985
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Provider Business Mailing Address
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Address Line | 466 2ND ST
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-3127
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Country | US
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Telephone | 503-636-6900
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Fax | 503-636-2985
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN J OLSEN
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Credential | OD
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Telephone | 503-636-6900
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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 | 1934T
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License Number State | OR
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