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General NPI Number Information
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NPI Number | 1447457452
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Entity Type | Individual
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Provider Name | AMI RENEE HALVORSON O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 1331 NW LOVEJOY ST STE 750
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City | PORTLAND
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State | OR
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Zip | 97209-3281
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Country | US
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Telephone | 503-535-2883
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Fax | 503-535-2887
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Provider Business Mailing Address
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Address Line | PO BOX 1506
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City | CHEHALIS
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State | WA
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Zip | 98532-0409
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Country | US
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Telephone | 360-242-3010
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00004138
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License Number State | WA
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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 | 3218ATI
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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 | OD4138
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ATI3218
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License Number State | OR
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