NPI 1073756573 · live from the CMS NPI Registry
Angela Ardiss, O.D.
Optometrist in Portland, OR. National Provider Identifier 1073756573, active.
NPI record
| NPI | 1073756573 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 14740 Nw Cornell Rd Ste 110, Portland, OR 97229 |
| Practice phone | 503-645-8002 |
| Enumerated | April 14, 2009 |
| Last updated | December 4, 2012 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist primary | 152W00000X | 2506ATI (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.