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General NPI Number Information
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NPI Number | 1487645586
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Entity Type | Individual
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Provider Name | LORNE YUDCOVITCH O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 2043 COLLEGE WAY
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City | FOREST GROVE
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State | OR
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Zip | 97116-1756
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Country | US
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Telephone | 503-352-2781
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Fax |
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Provider Business Mailing Address
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Address Line | 22165 NE FRYER HILL RD
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City | DUNDEE
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State | OR
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Zip | 97115-9179
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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 |
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 2588AT
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 2588AT
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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 | 2588AT
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License Number State | OR
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