Basic Information
| Provider Information | |||||||||
| NPI: | 1215073267 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH PORTLAND OPTICAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17121 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972170121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032855956 | ||||||||
| FaxNumber: | 5032857859 | ||||||||
| Practice Location | |||||||||
| Address1: | 3246 N LOMBARD ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972171206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032855956 | ||||||||
| FaxNumber: | 5032857859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NEMARUNDWE | ||||||||
| AuthorizedOfficialFirstName: | THELMA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5032851671 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OR | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 156FC0800X | OR | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Contact Lens | 156FX1800X | OR | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.