Provider Demographics
NPI:1891925947
Name:LAYOSA, JENNIFER LEI MARIKO (OD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEI MARIKO
Last Name:LAYOSA
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 1:1091 NE ORENCO STATION PKWY
Mailing Address - Street 2:E205
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-4431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1260 LLOYD CTR
Practice Address - Street 2:INSIDE SEARS OPTICAL
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1301
Practice Address - Country:US
Practice Address - Phone:503-331-3984
Practice Address - Fax:503-331-6237
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3322ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist