Individual
DR. LORNE YUDCOVITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2043 COLLEGE WAY, FOREST GROVE, OR 97116-1756
(503) 352-2781
Mailing address
22165 NE FRYER HILL RD, DUNDEE, OR 97115-9179
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2588AT
OR
152WC0802X
Corneal and Contact Management Optometrist
2588AT
OR
152WP0200X
Pediatric Optometrist
2588AT
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168366
—
OR
01
—
2588AT
STATE OPTOMETRY LICENSE #
OR
01
—
300200803
BC HMO/FC 65
—
01
—
5255690001
DMERC
—
01
—
831474004
BLUE CROSS BLUE SHIELD
—
Enumeration date
10/31/2005
Last updated
04/13/2020
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