Provider Demographics
NPI:1235656547
Name:DORAZIO, DOMINIC JEROME (OD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:JEROME
Last Name:DORAZIO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1523
Mailing Address - Country:US
Mailing Address - Phone:503-656-4221
Mailing Address - Fax:503-656-4249
Practice Address - Street 1:12050 SE STEVENS RD STE 100
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7667
Practice Address - Country:US
Practice Address - Phone:503-656-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT4480152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist