Individual
CHARLES DUANE RADEBAUGH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1800 CENTENNIAL BLVD, SUITE 2, SPRINGFIELD, OR 97477-4385
(541) 726-5055
Mailing address
1800 CENTENNIAL BLVD, SUITE 2, SPRINGFIELD, OR 97477-4385
(541) 726-5055
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1193T
OR
152W00000X
Optometrist
3463
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167197
—
OR
Enumeration date
11/17/2005
Last updated
07/08/2007
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