MEDICARE: PHILIP Y PADEN EYE CARE OPTICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	13653	OR

General Provider Information

NPI Number	:	1043213143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILIP Y PADEN EYE CARE OPTICAL

Provider Business Mailing Address
First Line	:	221 W STEWART AVE
Second Line	:	STE 110
City	:	MEDFORD
State	:	OR
Zip	:	97501-3647
Country	:	US
Telephone Number	:	541-776-9026
Fax Number	:	541-776-9096

Provider Business Practice Location Address
First Line	:	221 W STEWART AVE
Second Line	:	STE 110
City	:	MEDFORD
State	:	OR
Zip	:	97501-3647
Country	:	US
Telephone Number	:	541-776-9026
Fax Number	:	541-776-9096

Authorized Official
Title or Position	:	SYSTEMS ADMINISTRATOR
Name	:	MS. VIRGINIA M BROOKS
Credential	:
Telephone Number	:	541-494-5322

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	09/17/2008

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Directions to “PHILIP Y PADEN EYE CARE OPTICAL ” Practice Location

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