Individual
DR. NATHANIEL ROLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1955 NW NORTHRUP ST, PORTLAND, OR 97209-1614
(503) 227-2020
(503) 222-0614
Mailing address
1955 NW NORTHRUP ST, PORTLAND, OR 97209-1614
(503) 227-2020
(503) 222-0614
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4046ATI
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4046ATI
OPTOMETRIC LICENSE
OR
Enumeration date
09/07/2005
Last updated
11/15/2019
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