Provider Demographics
NPI:1508141656
Name:TASRIPIN, AMAND STEPHEN (OD)
Entity type:Individual
Prefix:MR
First Name:AMAND
Middle Name:STEPHEN
Last Name:TASRIPIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12923 NW CORNELL RD STE 203
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5834
Mailing Address - Country:US
Mailing Address - Phone:503-645-5076
Mailing Address - Fax:
Practice Address - Street 1:12923 NW CORNELL RD STE 203
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5834
Practice Address - Country:US
Practice Address - Phone:503-645-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATI3577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist