Provider Demographics
NPI:1790846251
Name:MACPHEE, MEL G (OD)
Entity Type:Individual
Prefix:DR
First Name:MEL
Middle Name:G
Last Name:MACPHEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SE 223RD AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2577
Mailing Address - Country:US
Mailing Address - Phone:503-492-2020
Mailing Address - Fax:503-465-6825
Practice Address - Street 1:1201 SE 223RD AVE STE 160
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2577
Practice Address - Country:US
Practice Address - Phone:503-492-2020
Practice Address - Fax:503-465-6825
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1647T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR290163Medicaid
OR290163Medicaid
ORR0000PHDBQMedicare PIN