Provider Demographics
NPI:1962641654
Name:MT SCOTT VISION AND OCULAR IMAGING CENTER PC
Entity Type:Organization
Organization Name:MT SCOTT VISION AND OCULAR IMAGING CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-250-0040
Mailing Address - Street 1:11002 NE 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-1584
Mailing Address - Country:US
Mailing Address - Phone:503-652-1479
Mailing Address - Fax:503-652-1690
Practice Address - Street 1:9300 NE 91ST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086
Practice Address - Country:US
Practice Address - Phone:503-652-1479
Practice Address - Fax:503-652-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3003AIT152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty