# SISKIYOU OPTICAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ashland Optical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376855924
- **Authorized official:** MS. BELMIRA PARDAL BORG (ADMINISTRATOR)
- **Authorized official phone:** (541) 482-8100

## Contact information

- **Practice address:** 648 N MAIN ST, ASHLAND, OR 97520-1710
- **Practice address phone:** (541) 482-8100
- **Practice address fax:** (541) 488-5081
- **Mailing address:** 648 N MAIN ST, ASHLAND, OR 97520-1710
- **Mailing address phone:** (541) 482-8100
- **Mailing address fax:** (541) 488-5081

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/12/2010
- **Last updated:** 10/01/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 001121000 00 | BLUE CROSS/BLUE SHIELD | OR |