Provider Demographics
NPI:1376176511
Name:MODERN EYE CARE OF PORTLAND LLC
Entity Type:Organization
Organization Name:MODERN EYE CARE OF PORTLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SADAF
Authorized Official - Middle Name:
Authorized Official - Last Name:SABAHI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-803-4134
Mailing Address - Street 1:7417 SW BEAVERTON HILLSDALE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-2100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7417 SW BEAVERTON HILLSDALE HWY STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-2100
Practice Address - Country:US
Practice Address - Phone:503-803-4134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty