Provider Demographics
NPI:1235325333
Name:MYOPTIC OPTOMETRY, LLC
Entity Type:Organization
Organization Name:MYOPTIC OPTOMETRY, LLC
Other - Org Name:DR. SUMMY TO, OPTOMETRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YUESUM
Authorized Official - Middle Name:
Authorized Official - Last Name:TO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-493-7070
Mailing Address - Street 1:3978 N WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1445
Mailing Address - Country:US
Mailing Address - Phone:503-493-7070
Mailing Address - Fax:503-715-0504
Practice Address - Street 1:3333 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4244
Practice Address - Country:US
Practice Address - Phone:503-335-7173
Practice Address - Fax:503-335-7973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3153AT305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service