Provider First Line Business Practice Location Address: 
PACIFIC UNIVERSITY COLLEGE OF OPTOMETRY
    Provider Second Line Business Practice Location Address: 
2043 COLLEGE WAY
    Provider Business Practice Location Address City Name: 
FOREST GROVE
    Provider Business Practice Location Address State Name: 
OR
    Provider Business Practice Location Address Postal Code: 
97116-1797
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
503-352-2020
    Provider Business Practice Location Address Fax Number: 
503-352-2929
    Provider Enumeration Date: 
06/22/2006