Organization
FOREST GROVE MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD C RICHARDSON OD (PRESIDENT)
(503) 357-2020
Entity
Organization
Contact information
Practice address
2804 19TH AVE, FOREST GROVE, OR 97116-2625
(503) 357-2020
(503) 357-6995
Mailing address
PO BOX 38, FOREST GROVE, OR 97116-0038
(503) 357-2020
(503) 357-6995
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
01/11/2012
Last updated
01/11/2012
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