Provider Demographics
NPI:1508926338
Name:THAYER, DAVID (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:THAYER
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:THAYER
Other - Middle Name:
Other - Last Name:OPTICAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1075 SE BASELINE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4394
Mailing Address - Country:US
Mailing Address - Phone:503-648-5236
Mailing Address - Fax:
Practice Address - Street 1:1075 SE BASELINE ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4394
Practice Address - Country:US
Practice Address - Phone:503-648-5236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies