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General NPI Number Information
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NPI Number | 1447280490
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Entity Type | Organization
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Legal Business Name | GRESHAM VISION CENTER, INC
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 39400 PIONEER BLVD STE 3
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City | SANDY
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State | OR
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Zip | 97055-8000
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Country | US
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Telephone | 503-668-4313
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Fax | 503-668-5963
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Provider Business Mailing Address
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Address Line | 39400 PIONEER BLVD STE 3
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City | SANDY
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State | OR
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Zip | 97055-8000
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Country | US
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Telephone | 503-668-4313
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Fax | 503-668-5963
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DIANE GARDNER
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Credential |
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Telephone | 503-665-3813
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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 | 1627ATI
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2474ATI
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T67476
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License Number State | OR
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