Provider Demographics
NPI:1992796668
Name:ZELADA, ARMANDO JERRY (OD)
Entity type:Individual
Prefix:DR
First Name:ARMANDO
Middle Name:JERRY
Last Name:ZELADA
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 1:2480 NE FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2509
Mailing Address - Country:US
Mailing Address - Phone:503-284-3937
Mailing Address - Fax:503-281-5711
Practice Address - Street 1:2480 NE FREMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2509
Practice Address - Country:US
Practice Address - Phone:503-284-3937
Practice Address - Fax:503-281-5711
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1808ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR008479Medicaid
410018909OtherRAILROAD MEDICARE
ORU11640Medicare UPIN
410018909OtherRAILROAD MEDICARE