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NPI Code Detail

MEDICARE: DR. BETH RACHEL GABBARD O.D.

MEDICARE: DR. BETH RACHEL GABBARD O.D.
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
1152W00000XOptometrist6553TTX
2152W00000XOptometrist046-009692IL
3152W00000XOptometristOD 60529922WA
4152W00000XOptometrist3556ATOR

General Provider Information

NPI Number : 1518902089
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BETH RACHEL GABBARD O.D.
Provider Business Mailing Address
First Line : 19500 SE STARK ST
Second Line :
City : PORTLAND
State : OR
Zip : 97233-5757
Country : US
Telephone Number : 800-813-2000
Fax Number :
Provider Business Practice Location Address
First Line : 19500 SE STARK ST
Second Line :
City : PORTLAND
State : OR
Zip : 97233-5757
Country : US
Telephone Number : 800-813-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2006
Last Update Date : 02/04/2022

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