Individual
DEREK JEN KON LOUIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS, MS, OD
Contact information
Practice address
3375 SW TERWILLIGER BLVD, PORTLAND, OR 97239
(503) 494-3000
(503) 494-3909
Mailing address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(503) 494-3000
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3196ATI
OR
Other
Enumeration date
01/17/2007
Last updated
02/24/2022
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