Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FC0800X | Contact Lens | DO00001793 | WA |
N | 156FX1800X | Optician | DO00001793 | WA |
NPI | 1437241825 |
---|---|
Provider Name | Mr. Robert Oun |
First Address | Portland, OR 97233-5757 |
Second Address | Portland, OR 97233-5757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 16/07/2007 |