Organization
GRESHAM VISION CENTER, INC
Active
Parent organization
R104410
Organization subpart
Yes
Provider details
NPI number
Legal business name
R104410
Authorized official
DIANE GARDNER (OFFICE MANAGER)
(503) 665-3813
Entity
Organization
Contact information
Practice address
125 NW MILLER AVE, GRESHAM, OR 97030-7225
(503) 665-3813
Mailing address
125 NW MILLER AVE, GRESHAM, OR 97030-7225
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
01/24/2007
Last updated
03/19/2015
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