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General NPI Number Information
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NPI Number | 1629069547
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Entity Type | Individual
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Provider Name | RICHARD LONDON O.D., M.A.
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 511 SW 10TH AVE SUITE 500
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City | PORTLAND
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State | OR
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Zip | 97205-2732
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Country | US
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Telephone | 503-352-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 5676 YORKSHIRE CT
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-8764
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 2909T
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License Number State | OR
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