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General NPI Number Information
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NPI Number | 1447306360
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Entity Type | Individual
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Provider Name | NANCY BROCK O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 13180 SE 169TH AVE STE 104
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City | HAPPY VALLEY
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State | OR
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Zip | 97086
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Country | US
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Telephone | 503-698-2375
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Fax | 503-698-3398
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Provider Business Mailing Address
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Address Line | 13180 SE 169TH AVE STE 104
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-8727
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Country | US
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Telephone | 503-997-6763
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Fax | 503-698-3398
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 2628ATI
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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 | 2826ATI
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License Number State | OR
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