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General NPI Number Information
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NPI Number | 1487786455
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Entity Type | Organization
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Legal Business Name | VISION PENDLETON, LLC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 1815 SW EMIGRANT AVE
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City | PENDLETON
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State | OR
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Zip | 97801-1843
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Country | US
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Telephone | 541-276-3653
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Fax | 541-966-4322
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Provider Business Mailing Address
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Address Line | 1815 SW EMIGRANT AVE
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City | PENDLETON
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State | OR
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Zip | 97801-1843
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Country | US
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Telephone | 541-276-3653
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Fax | 541-966-4322
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELLE M MONKMAN
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Credential | OD
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Telephone | 541-276-3653
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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 | 2456ATI
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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 | 2399ATI
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License Number State | OR
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