Provider Demographics
NPI:1932297371
Name:TAYLOR, PAULA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:ANN
Last Name:TAYLOR
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 1:2207 PORTLAND RD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1371
Mailing Address - Country:US
Mailing Address - Phone:503-538-3277
Mailing Address - Fax:
Practice Address - Street 1:2207 PORTLAND RD STE A
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1371
Practice Address - Country:US
Practice Address - Phone:503-538-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3200ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR138306OtherMEDICARE PTAN
OR006222Medicaid