Individual
JESSICA DENA BONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3838 N MISSISSIPPI AVE, PORTLAND, OR 97227-1161
(503) 206-3937
Mailing address
490 NW LOST SPRINGS TER STE 204, PORTLAND, OR 97229-6643
(949) 836-1749
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4512
OR
Other
Enumeration date
05/06/2020
Last updated
06/18/2020
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