1811935331 NPI number — DR. HANNU ROBERT VILJO LAUKKANEN O.D.

Table of content: DR. HANNU ROBERT VILJO LAUKKANEN O.D. (NPI 1811935331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811935331 NPI number — DR. HANNU ROBERT VILJO LAUKKANEN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAUKKANEN
Provider First Name:
HANNU
Provider Middle Name:
ROBERT VILJO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAUKKANEN
Provider Other First Name:
HANNU
Provider Other Middle Name:
ROBERT VILJO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1811935331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2043 COLLEGE WAY
Provider Second Line Business Mailing Address:
PACIFIC UNIVERSITY COLLEGE OF OPTOMETRY
Provider Business Mailing Address City Name:
FOREST GROVE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97116-1756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-352-2751
Provider Business Mailing Address Fax Number:
503-352-2929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2043 COLLEGE WAY
Provider Second Line Business Practice Location Address:
PACIFIC UNIVERSITY COLLEGE OF OPTOMETRY
Provider Business Practice Location Address City Name:
FOREST GROVE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97116-1756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-352-2751
Provider Business Practice Location Address Fax Number:
503-352-2929
Provider Enumeration Date:
06/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1599TX , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 152WV0400X , with the licence number: 1706ATI , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 034830 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".