Provider Demographics
NPI:1629171954
Name:WENTZIEN, JAMES BOND (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BOND
Last Name:WENTZIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3254 SE CRYSTAL SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-8565
Mailing Address - Country:US
Mailing Address - Phone:503-775-3655
Mailing Address - Fax:
Practice Address - Street 1:12100 SE STEVENS CT., STE 106
Practice Address - Street 2:CLASKAMAS EYECARE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-7266
Practice Address - Country:US
Practice Address - Phone:503-653-1442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR MD17537207W00000X
WAWA MD00035028207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology