Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4466 | OR |
NPI | 1003475625 |
---|---|
Provider Name | Dr. Chelsea Nicole Territo |
First Address | Beaverton, OR 97006-7451 |
Second Address | Beaverton, OR 97006-7451 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2019 |
Last Update Date | 17/06/2020 |