Individual
DR. NANCY BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
13180 SE 169TH AVE STE 104, HAPPY VALLEY, OR 97086
(503) 698-2375
(503) 698-3398
Mailing address
13180 SE 169TH AVE STE 104, HAPPY VALLEY, OR 97086-8727
(503) 997-6763
(503) 698-3398
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2826ATI
OR
152WP0200X
Pediatric Optometrist
2628ATI
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1508037607
ORGANIZATION (GROUP) NPI
—
01
—
R0000WDBCW
MEDICARE GROUP PIN
—
Enumeration date
01/25/2007
Last updated
03/26/2025
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