Individual
DR. AMI RENEE HALVORSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1331 NW LOVEJOY ST STE 750, PORTLAND, OR 97209-3281
(503) 535-2883
(503) 535-2887
Mailing address
PO BOX 1506, CHEHALIS, WA 98532-0409
(360) 242-3010
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
3218ATI
OR
152W00000X
Optometrist
Primary
ATI3218
OR
152W00000X
Optometrist
OD00004138
WA
152W00000X
Optometrist
OD4138
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2040883
—
WA
05
—
500609625
—
OR
01
—
G8934636
MEDICARE WA
WA
01
—
G8934637
MEDICARE WA
WA
01
—
G8934638
MEDICARE WA
WA
01
—
G8934639
MEDICARE WA
WA
01
—
G8934640
MEDICARE WA
WA
01
—
R177569
MEDICARE OR
OR
Enumeration date
07/02/2007
Last updated
11/19/2020
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