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15259 Se 82nd Dr, Suite 101, Clackamas, OR 97015-6609 | |
| (503) 657-0321 | |
| (503) 657-7066 |
| Full Name | |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 15259 Se 82nd Dr, Clackamas, Oregon |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669856902 | NPI | - | NPPES |
| 0213843 | Other | WA | WORKER'S COMPENSATOIN |
| 282442 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 1620ATI (Oregon) | Primary |
| 152WV0400X | Optometrist - Vision Therapy | 1620ATI (Oregon) | Secondary |
| Provider Name | Bruce R Wojciechowski |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1437247533 PECOS PAC ID: 7517900202 Enrollment ID: I20050712000076 |
| Provider Name | John W Reski |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1326200809 PECOS PAC ID: 4981771995 Enrollment ID: I20081009000384 |
| Provider Name | Julia I Sirianni |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1023344124 PECOS PAC ID: 3577713528 Enrollment ID: I20170421001683 |
| Mailing Address | Practice Location Address |
|---|---|
15259 Se 82nd Dr, Suite 101, Clackamas, OR 97015-6609 Ph: (503) 657-0321 | 15259 Se 82nd Dr, Suite 101, Clackamas, OR 97015-6609 Ph: (503) 657-0321 |
Derik Hardesty, OD Optometrist Medicare: Medicare Enrolled Practice Location: 12000 Se 82nd Ave, Clackamas, OR 97086 Phone: 503-659-5947 | |
Dr. Julia Sirianni, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 15259 Se 82nd Dr Ste 101, Clackamas, OR 97015 Phone: 503-657-0321 Fax: 503-657-7066 | |
Allie De La Cruz, Optometrist Medicare: Medicare Enrolled Practice Location: 15259 Se 82nd Dr Ste 101, Clackamas, OR 97015 Phone: 503-657-0321 | |
Jonathan Jay Attiyah, OD Optometrist Medicare: Not Enrolled in Medicare Practice Location: 15259 Se 82nd Dr Ste 101, Clackamas, OR 97015 Phone: 503-657-0321 Fax: 503-657-7066 | |
Rachel A Jorgensen, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 15259 Se 82nd Dr Ste 101, Clackamas, OR 97015 Phone: 503-657-0321 | |
John William Reski, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 15259 Se 82nd Dr, Suite 101, Clackamas, OR 97015 Phone: 503-657-0321 Fax: 503-657-7066 | |
Mark Edward Mclain, O.D. Optometrist Medicare: Medicare Enrolled Practice Location: 12100 Se Stevens Ct Suite 106, Clackamas, OR 97086 Phone: 503-353-7269 |