Eyedentity Vision Center P.c.

NPI #1003930132 in Portland, Oregon

Provider Information

NPI Number: 1003930132
Entity Type: Organization
Organization Name: Eyedentity Vision Center P.c.
Primary Specialty: Optometrist
Enumeration Date: Mar 16, 2007
Last Updated: Oct 16, 2009

Practice Location

Address: 2609 SE CLINTON ST
City: Portland
State: Oregon
ZIP Code: 97202-1240
Phone: (503) 238-1139

Authorized Official

Name: DR. STEVEN J CLOUSE, OD
Title: PRESIDENT
Phone: (503) 238-1139

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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