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General NPI Number Information
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NPI Number | 1760276612
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Entity Type | Organization
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Legal Business Name | GRAPEVINE VISION LLC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 7421 SW BARBUR BLVD STE 120
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City | PORTLAND
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State | OR
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Zip | 97219-2887
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Country | US
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Telephone | 503-343-1603
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Fax | 503-343-1604
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Provider Business Mailing Address
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Address Line | 7421 SW BARBUR BLVD STE 120
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City | PORTLAND
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State | OR
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Zip | 97219-2887
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Country | US
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Telephone | 503-343-1603
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Fax | 503-343-1604
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Authorized Official
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Title or Position | OWNER
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Name | ANNA MCCANN
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Credential | OD
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Telephone | 815-701-8221
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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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