NPI 1649690314 · live from the CMS NPI Registry
Charles Bong, O.D.
Optometrist in Gresham, OR. National Provider Identifier 1649690314, active.
NPI record
| NPI | 1649690314 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 1201 Se 223rd Ave Ste 160, Gresham, OR 97030 |
| Practice phone | 503-492-2020 |
| Mailing address | 12822 Se 157th Ave Unit 202, Happy Valley, OR 97086 |
| Enumerated | April 22, 2014 |
| Last updated | June 14, 2021 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist | 152W00000X | 27OA00651800 (NJ) |
| Optometrist primary | 152W00000X | AT4555 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.