Individual
KENNETH JAMES ERDMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
12300 SE 82ND AVE, JCPENNEY OPTICAL, PORTLAND, OR 97266-7717
(503) 653-5935
Mailing address
5722 NW 203RD PL, PORTLAND, OR 97229-7187
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2989T
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
075 0553367
EYEMED
OR
Enumeration date
03/14/2007
Last updated
07/08/2007
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