Organization
MADRAS VISION SOURCE PC
Active
Parent organization
MADRAS VISION SOURCE PC
Other names
Madras Vision Source LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MADRAS VISION SOURCE PC
Authorized official
JESSICA BROOKE TEGAN OD (OWNER)
(541) 475-2020
Entity
Organization
Contact information
Practice address
211 SE 5TH ST, MADRAS, OR 97741
(541) 475-2020
(541) 475-6118
Mailing address
211 SE 5TH ST, MADRAS, OR 97741
(541) 475-2020
(541) 475-6118
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3215ATI
OR
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
12/15/2011
Last updated
05/17/2022
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