Individual
BRAD FORTUNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD PHD
Contact information
Practice address
1040 NW 22ND AVENUE, DEVERS EYE INSTITUTE, PORTLAND, OR 97210
(503) 413-1198
(503) 413-5179
Mailing address
1225 NE SECOND AVENUE, 3RD FLOOR DISCOVERIES IN SIGHT, PORTLAND, OR 97232
(503) 413-1198
(503) 413-5179
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2824T
OR
152W00000X
Optometrist
9833
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
228831
—
OR
Enumeration date
11/15/2006
Last updated
07/08/2007
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