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General NPI Number Information
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NPI Number | 1821282609
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Entity Type | Individual
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Provider Name | MILA IOUSSIFOVA OD, CNS, FAAO
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Gender | Female
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 3615 SW RIVER PKWY
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City | PORTLAND
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State | OR
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Zip | 97239-4552
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Country | US
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Telephone | 971-229-0820
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Fax | 971-229-0821
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Provider Business Mailing Address
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Address Line | 3615 SW RIVER PKWY
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City | PORTLAND
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State | OR
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Zip | 97239-4552
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Country | US
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Telephone | 971-229-0820
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Fax | 971-229-0821
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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 | 3296AT
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License Number State | OR
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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 | ATI3296
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License Number State | OR
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