Basic Information
| Provider Information | |||||||||
| NPI: | 1588139539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | SCOTTY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3800 NW COLUMBIA AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972293273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036290366 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10104 SW WASHINGTON SQUARE RD | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972234457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039685437 | ||||||||
| FaxNumber: | 5033595929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2018 | ||||||||
| LastUpdateDate: | 06/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4378ATI | OR | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.