MEDICARE: TSO PORTLAND PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1245811850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TSO PORTLAND PLLC

Provider Business Mailing Address
First Line	:	1253 US HIGHWAY 181
Second Line	:
City	:	PORTLAND
State	:	TX
Zip	:	78374-1721
Country	:	US
Telephone Number	:	361-643-1516
Fax Number	:

Provider Business Practice Location Address
First Line	:	1253 US HIGHWAY 181
Second Line	:
City	:	PORTLAND
State	:	TX
Zip	:	78374-1721
Country	:	US
Telephone Number	:	361-643-1516
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DARRIN C SHANDLEY
Credential	:
Telephone Number	:	979-417-8021

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	08/07/2024

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Directions to “TSO PORTLAND PLLC ” Practice Location

Language	Start Address	Practice Location

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