Organization
BAY OPTICAL LABORATORY CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LILY M. VAN ELSBERG (ASSISTANT MANAGER/BOOKKEEPER)
(541) 756-2571
Entity
Organization
Contact information
Practice address
3587 BROADWAY ST, NORTH BEND, OR 97459-1251
(541) 756-2571
(541) 756-3976
Mailing address
3587 BROADWAY ST, NORTH BEND, OR 97459-1251
(541) 756-2571
(541) 756-3976
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009759000
PROVIDER NUMBER
OR
05
—
012641
—
OR
Enumeration date
06/11/2006
Last updated
07/16/2008
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