Individual
BRETT AGOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
125 NW MILLER, GRESHAM, OR 97030
(503) 665-3813
(503) 492-2313
Mailing address
125 NW MILLER, GRESHAM, OR 97030
(503) 665-3813
(503) 492-2313
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2497ATI
OR
152W00000X
Optometrist
2497T
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120167
—
OR
Enumeration date
08/19/2005
Last updated
07/28/2010
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