Provider Demographics
NPI:1386652220
Name:DELPLANCHE, REMY JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:REMY
Middle Name:JOHN
Last Name:DELPLANCHE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:REMY
Other - Middle Name:JOHN
Other - Last Name:DELPLANCHE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:4280 SW CEDAR HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2029
Mailing Address - Country:US
Mailing Address - Phone:503-644-5665
Mailing Address - Fax:503-646-6046
Practice Address - Street 1:4280 SW CEDAR HILLS BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005
Practice Address - Country:US
Practice Address - Phone:503-644-5665
Practice Address - Fax:503-646-6046
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3001ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR120290Medicaid
OR0918770001Medicare NSC
ORR136788Medicare PIN