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Organization
MEDICAL EYE CENTER INC
Active
Organization
MEDICAL EYE CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH CASEBOLT (CEO)
(541) 779-4711
Entity
Organization
Contact information
Practice address
1333 E BARNETT RD, MEDFORD, OR 97504-8219
(541) 779-4711
(541) 618-1485
Mailing address
1333 E BARNETT RD, MEDFORD, OR 97504-8219
(541) 779-4711
(541) 618-1485
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NULL
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
181860972
RAILROAD MEDICARE
—
05
—
212605
—
OR
Enumeration date
12/01/2006
Last updated
07/26/2017
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