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General NPI Number Information
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NPI Number | 1518302918
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Entity Type | Organization
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Legal Business Name | CASCADE VISION CENTER INC.
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 1201 SE 223RD AVE SUITE 160
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City | GRESHAM
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State | OR
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Zip | 97030-2574
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Country | US
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Telephone | 503-492-2020
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Fax | 503-465-6825
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Provider Business Mailing Address
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Address Line | 1201 SE 223RD AVE STE 160
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City | GRESHAM
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State | OR
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Zip | 97030-2577
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Country | US
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Telephone | 503-492-2020
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MEL G. MACPHEE
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Credential | D.O.
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Telephone | 503-492-2020
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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 | 1647T
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License Number State | OR
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