Provider Demographics
NPI:1528216793
Name:BREEDEN, CARRIE LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:LYNN
Last Name:BREEDEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9201 SE 91ST AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97086-3760
Mailing Address - Country:US
Mailing Address - Phone:503-775-2424
Mailing Address - Fax:503-775-6181
Practice Address - Street 1:9201 SE 91ST AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97086-3760
Practice Address - Country:US
Practice Address - Phone:503-775-2424
Practice Address - Fax:503-775-6181
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3261ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR149917Medicare PIN