Provider Demographics
NPI:1245811850
Name:TSO PORTLAND PLLC
Entity type:Organization
Organization Name:TSO PORTLAND PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHANDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-417-8021
Mailing Address - Street 1:1253 US HIGHWAY 181
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-1721
Mailing Address - Country:US
Mailing Address - Phone:361-643-1516
Mailing Address - Fax:
Practice Address - Street 1:1253 US HIGHWAY 181
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-1721
Practice Address - Country:US
Practice Address - Phone:361-643-1516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty