Organization
CORNELL EYECARE GROUP, INC
Active
Other names
Cornell Eyecare Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD WAYNE LAWSON O.D. (PRESIDENT)
(503) 643-5556
Entity
Organization
Contact information
Practice address
12955 NW CORNELL RD, PORTLAND, OR 97229-5863
(503) 643-5556
(503) 641-2515
Mailing address
12955 NW CORNELL RD, PORTLAND, OR 97229-5863
(503) 643-5556
(503) 641-2515
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2784ATI
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18428-3
—
OR
Enumeration date
01/22/2007
Last updated
09/23/2008
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