Individual
ALEXA NICOLE THAVORN I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
11805 NW CEDAR FALLS DR STE 105, PORTLAND, OR 97229-2780
(503) 747-0265
Mailing address
2621 NE 7TH AVE APT 404, PORTLAND, OR 97212-3179
(714) 478-2676
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ATI4556
OR
Other
Enumeration date
02/01/2021
Last updated
02/01/2021
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