Provider Demographics
NPI:1811026719
Name:PHILLIPS, KATHERINE HESS (OD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HESS
Last Name:PHILLIPS
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 1:7535 SW BARNES RD
Mailing Address - Street 2:STE 111
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6269
Mailing Address - Country:US
Mailing Address - Phone:503-297-3233
Mailing Address - Fax:
Practice Address - Street 1:5335 MEADOWS RD
Practice Address - Street 2:SUITE 151
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3398
Practice Address - Country:US
Practice Address - Phone:503-684-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3123ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist