Provider Demographics
NPI:1245101393
Name:PORTLAND VISION LLC
Entity type:Organization
Organization Name:PORTLAND VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:510-734-4567
Mailing Address - Street 1:1204 SE LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6364
Mailing Address - Country:US
Mailing Address - Phone:510-734-4567
Mailing Address - Fax:
Practice Address - Street 1:1916 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1502
Practice Address - Country:US
Practice Address - Phone:503-546-4193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty