Provider Demographics
NPI:1780437871
Name:PORKAR REZAEIEH, AYDA (OD)
Entity type:Individual
Prefix:DR
First Name:AYDA
Middle Name:
Last Name:PORKAR REZAEIEH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AYDA
Other - Middle Name:
Other - Last Name:PORKAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1011 VALLEY RIVER WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2127
Mailing Address - Country:US
Mailing Address - Phone:541-342-2201
Mailing Address - Fax:
Practice Address - Street 1:1011 VALLEY RIVER WAY STE 110
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2127
Practice Address - Country:US
Practice Address - Phone:541-342-2201
Practice Address - Fax:541-229-8463
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATI4722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty