Individual
DR. BRET A. PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
9201 SE 91ST AVE, SUITE 210, CLACKAMAS, OR 97086-3760
(503) 775-2424
(503) 775-6181
Mailing address
9201 SE 91ST AVE, SUITE 210, CLACKAMAS, OR 97086-3760
(503) 775-2424
(503) 775-6181
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3132
OR
Other
Enumeration date
07/11/2006
Last updated
05/04/2010
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