Individual
TRAVIS PACK LAFAYETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
19500 SE STARK ST, PORTLAND, OR 97233-5757
(503) 669-3900
Mailing address
13865 SE 119TH DR, CLACKAMAS, OR 97015-7607
(503) 698-3662
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OR 2729T
OR
152W00000X
Optometrist
WA OD00003720
WA
Other
Enumeration date
08/17/2006
Last updated
07/08/2007
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