Individual
SANDRA GILLGAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11703 NE GLISAN ST, PORTLAND, OR 97220-2141
(503) 253-7839
Mailing address
11703 NE GLISAN ST, PORTLAND, OR 97220-2141
(503) 253-7839
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Enumeration date
03/08/2007
Last updated
07/08/2007
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