Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1101X | Ophthalmic Assistant | 96750 | OR |
Y | 156FX1800X | Optician | 22027 | OR |
NPI | 1265663173 |
---|---|
Provider Name | Mrs. Sheri Lynn Brooks |
First Address | Portland, OR 97215-1247 |
Second Address | Portland, OR 97215-1247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2009 |
Last Update Date | 28/07/2009 |