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General NPI Number Information
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NPI Number | 1578987616
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Entity Type | Organization
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Legal Business Name | PORTLAND EYE CLINIC LLC
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 8001 SE POWELL BLVD STE L
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City | PORTLAND
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State | OR
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Zip | 97206-2300
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Country | US
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Telephone | 503-775-3110
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Fax |
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Provider Business Mailing Address
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Address Line | 11461 SE HIGHLAND LOOP
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City | CLACKAMAS
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State | OR
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Zip | 97015-7238
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Country | US
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Telephone | 503-705-3222
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIER TRAN
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Credential | OD
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Telephone | 503-705-3222
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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 | 3306 ATI
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License Number State | OR
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