Provider Demographics
NPI:1326594987
Name:PDX EYE AND VISION CARE LLC
Entity Type:Organization
Organization Name:PDX EYE AND VISION CARE LLC
Other - Org Name:FREMONT FAMILY VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-284-3937
Mailing Address - Street 1:2480 NE FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2509
Mailing Address - Country:US
Mailing Address - Phone:503-284-3937
Mailing Address - Fax:503-281-5711
Practice Address - Street 1:2480 NE FREMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2509
Practice Address - Country:US
Practice Address - Phone:503-284-3937
Practice Address - Fax:503-281-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3568ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty