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Organization

EYEDENTITY VISION CENTER P.C.

Active
Other names
Steven J. Clouse, OD
Organization subpart
No

Provider details

NPI number
Authorized official
DR. STEVEN J CLOUSE OD (PRESIDENT)
(503) 238-1139
Entity
Organization

Contact information

Practice address
2609 SE CLINTON ST, PORTLAND, OR 97202-1240
(503) 238-1139
(503) 235-6574
Mailing address
2609 SE CLINTON ST, PORTLAND, OR 97202-1240
(503) 238-1139
(503) 235-6574

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2408T
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1285640714
DR. CLOUSE'S NPI
OR
Enumeration date
03/16/2007
Last updated
10/16/2009
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