MEDICARE: DR. PAUL M. STASIK 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
1	152W00000X	Optometrist	2936	OR
2	152W00000X	Optometrist	OD60913741	WA
3	152WC0802X	Corneal and Contact Management Optometrist	2936	OR

General Provider Information

NPI Number	:	1841222064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL M. STASIK O.D.

Provider Business Mailing Address
First Line	:	500 NE MULTNOMAH ST STE 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2031
Country	:	US
Telephone Number	:	800-813-2000
Fax Number	:	855-524-5255

Provider Business Practice Location Address
First Line	:	19500 SE STARK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97233-5792
Country	:	US
Telephone Number	:	800-813-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	12/11/2025

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