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Organization

SISKIYOU OPTICAL

Active
Other names
Ashland Optical
Organization subpart
No

Provider details

NPI number
Authorized official
MS. BELMIRA PARDAL BORG (ADMINISTRATOR)
(541) 482-8100
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
001121000 00
BLUE CROSS/BLUE SHIELD
OR
Enumeration date
07/12/2010
Last updated
10/01/2010
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