Provider Demographics
NPI:1366544041
Name:TOWN CENTER VISION LLC
Entity type:Organization
Organization Name:TOWN CENTER VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-652-1479
Mailing Address - Street 1:12000 SE 82ND AVE STE 2012
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-7721
Mailing Address - Country:US
Mailing Address - Phone:503-652-1479
Mailing Address - Fax:503-652-1690
Practice Address - Street 1:12000 SE 82ND AVE STE 2012
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-7721
Practice Address - Country:US
Practice Address - Phone:503-652-1479
Practice Address - Fax:503-652-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3003AIT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty