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NPI Code Detail

MEDICARE: EYE VISION DOCTOR LLC

MEDICARE: EYE VISION DOCTOR LLC
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1932964624
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYE VISION DOCTOR LLC
Provider Business Mailing Address
First Line : 7024 SW CHAPEL LN
Second Line :
City : PORTLAND
State : OR
Zip : 97223-7590
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 650 NE HOLLADAY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2035
Country : US
Telephone Number : 800-485-9196
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ELIZABETH SASS
Credential :
Telephone Number : 503-567-6749
Provider Enumeration Date : 02/21/2024
Last Update Date : 02/21/2024

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Directions to “EYE VISION DOCTOR LLC ” Practice Location

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