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General NPI Number Information
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NPI Number | 1871956136
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Entity Type | Individual
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Provider Name | ALISE NICHOLE ROBERSON O.D.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2016
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 3600 N INTERSTATE AVE
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City | PORTLAND
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State | OR
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Zip | 97227-1106
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Country | US
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Telephone | 503-249-3429
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 SW 10TH AVE APT 52
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City | PORTLAND
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State | OR
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Zip | 97239-3059
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Country | US
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Telephone | 949-303-8969
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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 | NOT YET ISSUED
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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 | 3671ATI
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License Number State | OR
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