| NPI | 1760641138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH MILLER Owner 503-860-6399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 1654AT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD00003109) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2016-09-29 |