Individual
DR. DARYN W. DERSTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
6539 SE MILWAUKIE AVE, PORTLAND, OR 97202-5519
(503) 236-6008
(503) 236-2057
Mailing address
6539 SE MILWAUKIE AVE, PORTLAND, OR 97202-5519
(503) 236-6008
(503) 236-2057
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2773ATI
OR
Other
Enumeration date
07/17/2006
Last updated
08/15/2019
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