Individual
JAMISON RILEY SOUPIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2043 COLLEGE WAY, FOREST GROVE, OR 97116-1756
(503) 352-3197
Mailing address
2043 COLLEGE WAY, FOREST GROVE, OR 97116-1756
(503) 352-3197
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4328AT
OR
Other
Enumeration date
08/04/2017
Last updated
07/21/2022
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