Provider Demographics
NPI:1972644490
Name:PIATZ BENCK, MARGARET MARY (OD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:MARY
Last Name:PIATZ BENCK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:52269 SE TYLER ST
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-3434
Mailing Address - Country:US
Mailing Address - Phone:503-543-8982
Mailing Address - Fax:
Practice Address - Street 1:1111 NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3902
Practice Address - Country:US
Practice Address - Phone:503-255-7782
Practice Address - Fax:503-255-7787
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2664 ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist