| NPI | 1023152238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAD WILLIS BUCKINGHAM Owner Physician 503-459-9247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 4022 ATI) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2020-08-22 |