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Organization
OPTICAL BROKERS
Active
Organization
OPTICAL BROKERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBRA KAY SUMMERS OPTICIAN (OWNER)
(503) 295-6488
Entity
Organization
Contact information
Practice address
134 NW 21ST AVE, PORTLAND, OR 97209-1002
(503) 295-6488
Mailing address
134 NW 21ST AVE, PORTLAND, OR 97209-1002
(503) 295-6488
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
156FX1100X
OR
Other
Enumeration date
05/24/2011
Last updated
05/24/2011
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