Provider Demographics
NPI:1295947745
Name:PORTER, STEVEN DEAN (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DEAN
Last Name:PORTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:DEAN
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:302 E SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2724
Mailing Address - Country:US
Mailing Address - Phone:503-256-7940
Mailing Address - Fax:503-256-7940
Practice Address - Street 1:4849 NE 138TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-3401
Practice Address - Country:US
Practice Address - Phone:503-256-7940
Practice Address - Fax:503-256-7940
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1723T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist