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General NPI Number Information
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NPI Number | 1578686002
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Entity Type | Organization
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Legal Business Name | KENTANA INC
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 01/03/2009
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Provider Practice Location Address
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Address Line | 22400 S SALAMO RD SUITE 100
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City | WEST LINN
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State | OR
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Zip | 97068-8269
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Country | US
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Telephone | 503-722-7737
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Fax | 503-722-4152
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Provider Business Mailing Address
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Address Line | 22400 S SALAMO RD SUITE 100
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City | WEST LINN
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State | OR
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Zip | 97068-8269
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Country | US
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Telephone | 503-722-7737
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Fax | 503-722-4152
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Authorized Official
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Title or Position | SECRETARY, KENTANA INC.
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Name | DR. BARBARA H BRISCOE
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Credential | O.D.
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Telephone | 503-722-7737
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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 |
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License Number State |
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