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General NPI Number Information
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NPI Number | 1780420265
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Entity Type | Organization
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Legal Business Name | MONTAVILLA VISION PROFESSIONALS
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Dates
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Enumeration Date | 07/03/2024
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 8315 SE STARK ST
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City | PORTLAND
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State | OR
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Zip | 97216-1143
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Country | US
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Telephone | 503-282-3070
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Fax | 503-287-3482
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Provider Business Mailing Address
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Address Line | 8315 SE STARK ST
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City | PORTLAND
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State | OR
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Zip | 97216-1143
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Country | US
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Telephone | 503-282-3070
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Fax | 503-287-3482
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANH T BUI
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Credential |
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Telephone | 503-282-3070
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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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