Provider Demographics
NPI:1710070222
Name:PRADHAN, JONA (OD)
Entity Type:Individual
Prefix:DR
First Name:JONA
Middle Name:
Last Name:PRADHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9225 SW HALL BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6794
Mailing Address - Country:US
Mailing Address - Phone:503-598-8884
Mailing Address - Fax:503-598-8760
Practice Address - Street 1:9225 SW HALL BLVD STE C
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6794
Practice Address - Country:US
Practice Address - Phone:503-598-8884
Practice Address - Fax:503-598-8760
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2136T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist