Organization
LA GRANDE FAMILY EYE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL HEBER KIMBALL OD (OPTOMETRIST)
(541) 963-3788
Entity
Organization
Contact information
Practice address
1502 N PINE ST, LA GRANDE, OR 97850
(541) 963-3788
(541) 963-3091
Mailing address
1502 N PINE ST, LA GRANDE, OR 97850
(541) 963-3788
(541) 963-3091
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
3311AT
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500609247
—
OR
Enumeration date
07/17/2009
Last updated
09/09/2010
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