Provider Demographics
NPI:1841509924
Name:VIESTENZ, OLESYA
Entity type:Individual
Prefix:
First Name:OLESYA
Middle Name:
Last Name:VIESTENZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7485 SW BRIDGEPORT RD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7207
Mailing Address - Country:US
Mailing Address - Phone:503-495-5821
Mailing Address - Fax:
Practice Address - Street 1:7485 SW BRIDGEPORT RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7207
Practice Address - Country:US
Practice Address - Phone:503-495-5821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3521ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist