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Individual

LYLE HENRY REGIMBALD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
KAISER PERMANENTE INTERSTATE MEDICAL OFFICE CENTRAL, 3600 N INTERSTATE AVE, PORTLAND, OR 97227-1116
(503) 331-6330
Mailing address
KAISER PERMANENTE INTERSTATE MEDICAL OFFICE CENTRAL, 3600 N INTERSTATE AVE, PORTLAND, OR 97227-1116

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2884T
OR
152W00000X
Optometrist
4041
WA

Other

Enumeration date
08/31/2006
Last updated
02/11/2022
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