| NPI | 1730106717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMAR NOLES O PT Ometrist 503-639-0488 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OR 1052ATI) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2020-08-22 |