Individual
MR. JOHN KENNAN NOVACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4855 SW WESTERN AVE, BEAVERTON, OR 97005-3460
(503) 643-7565
Mailing address
15100 SE GLADSTONE DR, PORTLAND, OR 97236-2445
(503) 762-4265
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
WA
Other
Enumeration date
08/29/2006
Last updated
07/08/2007
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