Provider Demographics
NPI:1780420265
Name:MONTAVILLA VISION PROFESSIONALS
Entity type:Organization
Organization Name:MONTAVILLA VISION PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANH
Authorized Official - Middle Name:T
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-282-3070
Mailing Address - Street 1:8315 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-1143
Mailing Address - Country:US
Mailing Address - Phone:503-282-3070
Mailing Address - Fax:503-287-3482
Practice Address - Street 1:8315 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-1143
Practice Address - Country:US
Practice Address - Phone:503-282-3070
Practice Address - Fax:503-287-3482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty