Organization
URBAN EYE GALLERY, LLC
Active
Other names
Eye Department
Organization subpart
No
Provider details
NPI number
Authorized official
ANITA PHROMSIVARAK BACON O.D. (MANAGING MEMBER)
(503) 227-0573
Entity
Organization
Contact information
Practice address
921 SW 16TH AVE, PORTLAND, OR 97205-1730
(503) 227-0573
Mailing address
921 SW 16TH AVE, PORTLAND, OR 97205-1730
(503) 227-0573
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3195 ATI
OR
Other
Enumeration date
06/07/2013
Last updated
06/07/2013
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