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General NPI Number Information
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NPI Number | 1760524268
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Entity Type | Individual
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Provider Name | SANDRA J. MIYAMOTO O.D.
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Gender | Female
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 4859 MEADOWS RD STE 155
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-2628
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Country | US
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Telephone | 503-342-6853
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Fax | 503-342-6185
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Provider Business Mailing Address
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Address Line | 4859 MEADOWS RD STE 155
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-2628
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Country | US
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Telephone | 503-342-6853
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 007047
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13422
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | AT4601
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License Number State | OR
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