NPI 1295915700 · live from the CMS NPI Registry
Broadway Vision World
Optometrist in Portland, OR. National Provider Identifier 1295915700, active.
NPI record
| NPI | 1295915700 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 1962 Sw Broadway, Portland, OR 97201 |
| Practice phone | 503-223-6655 |
| Mailing address | Po Box 108, Beaverton, OR 97075 |
| Enumerated | November 13, 2007 |
| Last updated | November 13, 2007 |
| Authorized official | Kamelia Massih, Ceo |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist primary | 152W00000X | 1863T (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.