Provider Demographics
NPI:1699733758
Name:BROPHY, GREG (OD)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:
Last Name:BROPHY
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 1:2150 NE DIVISION ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5813
Mailing Address - Country:US
Mailing Address - Phone:503-667-2424
Mailing Address - Fax:503-492-3236
Practice Address - Street 1:2150 NE DIVISION ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5813
Practice Address - Country:US
Practice Address - Phone:503-667-2424
Practice Address - Fax:503-492-3236
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1890T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202603709OtherTAX ID NUMBER