Organization
LASER & SURGICAL EYE CENTER LLC
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
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136452
—
OR
01
—
490003025
RAILROAD MEDICARE
—
Enumeration date
12/01/2006
Last updated
10/26/2009
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