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NPI Code Detail

MEDICARE: BAY OPTICAL LABORATORY CORP.

MEDICARE: BAY OPTICAL LABORATORY CORP.
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
1332H00000XEyewear Supplier

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20009759000OTHERORPROVIDER NUMBER

General Provider Information

NPI Number : 1407898026
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAY OPTICAL LABORATORY CORP.
Provider Business Mailing Address
First Line : 3587 BROADWAY ST
Second Line :
City : NORTH BEND
State : OR
Zip : 97459-1251
Country : US
Telephone Number : 541-756-2571
Fax Number : 541-756-3976
Provider Business Practice Location Address
First Line : 3587 BROADWAY ST
Second Line :
City : NORTH BEND
State : OR
Zip : 97459-1251
Country : US
Telephone Number : 541-756-2571
Fax Number : 541-756-3976
Authorized Official
Title or Position : ASSISTANT MANAGER/BOOKKEEPER
Name : LILY M. VAN ELSBERG
Credential :
Telephone Number : 541-756-2571
Provider Enumeration Date : 06/11/2006
Last Update Date : 07/16/2008

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Practice Location Address:
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1548261381 — DEBRA A. GRAHAM M.D.
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1356342950 — JANE GILBERT M.D.
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Practice Fax: 541-756-5783
1518038058 — BAY EYE CLINIC P.C.
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1508181355 — DR. PETER ALAN KARTH MD
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1336638618 — DR. HYUN SOO JANG MD
Practice Location Address:
3585 BROADWAY AVE
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97459-1251
Practice Phone: 541-756-2584
Practice Fax: 541-756-5783

Directions to “BAY OPTICAL LABORATORY CORP. ” Practice Location

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