Provider Demographics
NPI:1215073267
Name:NORTH PORTLAND OPTICAL
Entity type:Organization
Organization Name:NORTH PORTLAND OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMARUNDWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-285-1671
Mailing Address - Street 1:PO BOX 17121
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-0121
Mailing Address - Country:US
Mailing Address - Phone:503-285-5956
Mailing Address - Fax:503-285-7859
Practice Address - Street 1:3246 N LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-1206
Practice Address - Country:US
Practice Address - Phone:503-285-5956
Practice Address - Fax:503-285-7859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR152W00000X, 156FC0800X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Not Answered156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Single Specialty
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty