Individual
NILS KOFOED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
23500 NE SANDY BLVD, WOOD VILLAGE, OR 97060-9653
(503) 667-8869
Mailing address
16752 SE MARKET ST # B, PORTLAND, OR 97233-4426
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ATI4514
OR
Other
Enumeration date
06/16/2020
Last updated
09/17/2021
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