Provider Demographics
NPI:1417071861
Name:MASALMEH, JAMAL (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:
Last Name:MASALMEH
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 1:3303 S BOND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-494-3000
Mailing Address - Fax:503-418-0843
Practice Address - Street 1:3303 S BOND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-3000
Practice Address - Fax:503-418-0843
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003972152W00000X, 152WC0802X
OR2956ATI152WC0802X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH3451Medicaid
AZ794382Medicaid
WAWA1066OtherNBN
WA41268OtherSPECTERA
WA5665MAOtherREGBS OF WA
WAWA3972OtherEYEMED
030113Medicare Oscar/Certification
WAWA1066OtherNBN
WAWA3972OtherEYEMED
HSZ465RBVMedicare UPIN
AZ794382Medicaid