NPI 1124466545

Urban Eye Gallery, LLC

Organisation Optometrist Portland, OR

Practice location

Address: 921 SW 16th Ave, Portland, OR 97205-1730
Phone: (503) 227-0573

Authorised official

Name: Anita Phromsivarak Bacon
Title: Managing Member
Phone: (503) 227-0573

Registered specialties

Optometrist Primary

Eye and Vision Services Providers Taxonomy 152W00000X Licence 3195 ATI (OR)

Other Optometrist providers in Oregon →

Registry record

NPI: 1124466545
Entity type: Organization
NPI issued: 7 Jun 2013
Record last updated: 7 Jun 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.