Urban Eye Gallery, LLC

NPI #1124466545 in Portland, Oregon

Provider Information

NPI Number: 1124466545
Entity Type: Organization
Organization Name: Urban Eye Gallery, LLC
Primary Specialty: Optometrist
Enumeration Date: Jun 7, 2013
Last Updated: Jun 7, 2013

Practice Location

Address: 921 SW 16TH AVE
City: Portland
State: Oregon
ZIP Code: 97205-1730
Phone: (503) 227-0573

Authorized Official

Name: ANITA PHROMSIVARAK BACON, O.D.
Title: MANAGING MEMBER
Phone: (503) 227-0573

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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