Provider Demographics
NPI:1063269488
Name:DE LA CRUZ, ALLIE
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 SW GRIFFITH DR STE 165
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-8731
Mailing Address - Country:US
Mailing Address - Phone:503-646-8592
Mailing Address - Fax:503-526-3989
Practice Address - Street 1:4655 SW GRIFFITH DR STE 165
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-8731
Practice Address - Country:US
Practice Address - Phone:503-646-8592
Practice Address - Fax:503-526-3989
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATI4733152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist