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General NPI Number Information
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NPI Number | 1518350941
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Entity Type | Organization
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Legal Business Name | EYE IMPRESSIONS, LLC
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Dates
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Enumeration Date | 03/10/2015
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 20508 SW ROY ROGERS RD SUITE 125
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City | SHERWOOD
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State | OR
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Zip | 97140-9932
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Country | US
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Telephone | 502-625-0733
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Fax |
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Provider Business Mailing Address
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Address Line | 20508 SW ROY ROGERS RD SUITE 125
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City | SHERWOOD
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State | OR
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Zip | 97140-9932
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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 | OWNER
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Name | SHANNON DOWNEY
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Credential | OD
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Telephone | 503-625-0733
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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 | 3055ATI
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License Number State | OR
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