Provider Demographics
NPI:1740390558
Name:LASKE, NICOLE JANE (OD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:JANE
Last Name:LASKE
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:KAISER PERMANENTE SUNSET MEDICAL OFFICE
Mailing Address - Street 2:19400 NW EVERGREEN PWY
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7031
Mailing Address - Country:US
Mailing Address - Phone:503-690-5005
Mailing Address - Fax:
Practice Address - Street 1:KAISER PERMANENTE SUNSET MEDICAL OFFICE
Practice Address - Street 2:19400 NW EVERGREEN PWY
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7031
Practice Address - Country:US
Practice Address - Phone:503-690-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2783 ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist