Individual
MR. DEREK JAMES BUCHANAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
925 SW TAYLOR ST, PORTLAND, OR 97205-2503
(503) 228-2154
(503) 228-4694
Mailing address
925 SW TAYLOR ST, PORTLAND, OR 97205-2503
(503) 228-2154
(503) 228-4694
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
NOT APPLICABLE
OR
156FX1800X
Optician
Primary
NOT APPLICABLE
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
049424
—
OR
01
—
1931129593
VOCATIONAL REHAB VENDOR #
OR
05
—
278184
—
OR
01
—
838474000
REGENCE BCBS PROVIDER #
OR
01
—
J6344
PACIFIC SOURCE PROVIDER #
OR
01
—
OP1880
EYEMED PROVIDER #
OR
01
—
TIN CONFIDENTIAL
LIFEWISE
OR
Enumeration date
12/13/2006
Last updated
06/09/2008
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