Provider Demographics
NPI:1063623221
Name:KVORTEK, JOSEPH J (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:KVORTEK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 NW PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-7750
Mailing Address - Country:US
Mailing Address - Phone:541-447-4739
Mailing Address - Fax:
Practice Address - Street 1:3044 N HIGHWAY 97
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7512
Practice Address - Country:US
Practice Address - Phone:541-388-5716
Practice Address - Fax:541-617-7898
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1047T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist