Individual
DR. KEVIN DALE SICKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1265 JANTZEN BEACH CTR, PORTLAND, OR 97217-7852
(503) 289-7331
Mailing address
1265 JANTZEN BEACH CTR, PORTLAND, OR 97217-7852
(503) 289-7331
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2766T
OR
Other
Enumeration date
09/06/2007
Last updated
09/06/2007
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