Organization
MEDICAL EYE CENTER OPTICAL 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
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040654
—
OR
Enumeration date
12/01/2006
Last updated
01/14/2011
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