Individual
MRS. VAYAKONE PHILAVANH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
19500 SE STARK ST, PORTLAND, OR 97233-5757
(503) 669-3995
(503) 669-3956
Mailing address
22298 NE FAILING ST, FAIRVIEW, OR 97024-8758
(503) 669-3995
(503) 669-3656
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO00002172
WA
Other
Enumeration date
08/25/2006
Last updated
07/08/2007
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