| Parkrose Vision, Llc | |
|
4880 Ne 104th Ave Portland OR 97220 | |
| (503) 943-0699 | |
| Not Available |
| Full Name | Parkrose Vision, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4880 Ne 104th Ave, Portland, Oregon |
| Authorized Official Name and Position | Haley Kim (OWNER) |
| Authorized Official Contact | 5034328452 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Parkrose Vision, Llc 15470 Se Baden Powell Rd Happy Valley OR 97086-6049 Ph: (503) 819-1807 | Parkrose Vision, Llc 4880 Ne 104th Ave Portland OR 97220 Ph: (503) 943-0699 |
| NPI Number | 1144847260 |
|---|---|
| Provider Enumeration Date | 07/06/2020 |
| Last Update Date | 05/22/2024 |
| Medicare PECOS PAC ID | 6608277405 |
|---|---|
| Medicare Enrollment ID | O20241114004575 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144847260 | NPI | - | NPPES |
| 500784142 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Haley Kim |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1104483833 PECOS PAC ID: 2769805688 Enrollment ID: I20200710002722 |
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