Provider Demographics
NPI:1326200809
Name:RESKI, JOHN WILLIAM (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:RESKI
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 1:15259 SE 82ND DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6609
Mailing Address - Country:US
Mailing Address - Phone:503-657-0321
Mailing Address - Fax:503-657-7066
Practice Address - Street 1:15259 SE 82ND DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6609
Practice Address - Country:US
Practice Address - Phone:503-657-0321
Practice Address - Fax:503-657-7066
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3269ATI152WV0400X
WAOD60026416152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy