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General NPI Number Information
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NPI Number | 1831753219
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Entity Type | Organization
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Legal Business Name | MODERN OPTOMETRY LLC
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 8932 W MARSHALL AVE
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City | GLENDALE
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State | AZ
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Zip | 85305-2259
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Country | US
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Telephone | 503-702-4915
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Fax |
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Provider Business Mailing Address
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Address Line | 3616 R ST
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City | VANCOUVER
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State | WA
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Zip | 98663-2542
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Country | US
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Telephone | 503-702-4915
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LOIS FILIPELLI
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Credential | OD
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Telephone | 503-702-4915
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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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