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General NPI Number Information
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NPI Number | 1891925947
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Entity Type | Individual
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Provider Name | JENNIFER LEI MARIKO LAYOSA O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 1260 LLOYD CTR INSIDE SEARS OPTICAL
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City | PORTLAND
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State | OR
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Zip | 97232-1301
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Country | US
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Telephone | 503-331-3984
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Fax | 503-331-6237
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Provider Business Mailing Address
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Address Line | 1091 NE ORENCO STATION PKWY E205
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City | HILLSBORO
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State | OR
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Zip | 97124-4431
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Country | US
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Telephone |
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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 | 3322ATI
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License Number State | OR
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