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Organization

GRESHAM VISION SOURCE PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. TUAN TU NGUYEN OD (OPTOMETRIST OWNER)
(503) 669-1992
Entity
Organization

Contact information

Practice address
929 NE 181ST AVE, PORTLAND, OR 97230-6757
(503) 669-1992
(503) 618-8262
Mailing address
929 NE 181ST AVE, PORTLAND, OR 97230-6757
(503) 669-1992
(503) 618-8262

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2987AT
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
117114
GROUP PIN
OR
05
V07577
OR
Enumeration date
10/23/2006
Last updated
03/02/2018
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