Provider Demographics
NPI:1306077417
Name:MUNOZ, ELEANOR (OD)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 SW ALGONKIN ST
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9212
Mailing Address - Country:US
Mailing Address - Phone:971-732-9494
Mailing Address - Fax:
Practice Address - Street 1:9225 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6794
Practice Address - Country:US
Practice Address - Phone:503-598-8884
Practice Address - Fax:503-598-8760
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3330ATI152W00000X
WAOD60119602152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist