Provider Demographics
NPI:1114045457
Name:SCHOUTEN, ROBERT DEAN SR (O D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEAN
Last Name:SCHOUTEN
Suffix:SR
Gender:M
Credentials:O D
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:DEAN
Other - Last Name:SCHOUTEN
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:O D
Mailing Address - Street 1:9931 SE EASTMONT DR
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-8608
Mailing Address - Country:US
Mailing Address - Phone:503-663-2646
Mailing Address - Fax:503-663-0423
Practice Address - Street 1:1839 MOLALLA AVE
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4071
Practice Address - Country:US
Practice Address - Phone:503-656-2453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR983 T152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision