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Organization

ROGUE FAMILY EYE CARE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MATTHEW SCOT RICHARDSON OD (PRESIDENT, OPTOMETRIC PHYSICIAN)
(541) 474-2788
Entity
Organization

Contact information

Practice address
853 NE A ST, GRANTS PASS, OR 97526
(541) 218-9966
Mailing address
853 NE A ST, GRANTS PASS, OR 97526-2211
(541) 218-9966

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2980ATI
OR
152WP0200X
Pediatric Optometrist
2980ATI
OR
152WS0006X
Sports Vision Optometrist
152WV0400X
Vision Therapy Optometrist
2980ATI
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2980ATI
OREGON BOARD OF OPTOMETRY
OR
Enumeration date
07/20/2018
Last updated
02/24/2022
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