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NPI Code Detail

MEDICARE: MISS TONI MAE DECKER O.D.

MEDICARE: MISS TONI MAE DECKER O.D.
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
1152W00000XOptometrist3193ATIOR

General Provider Information

NPI Number : 1932299526
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS TONI MAE DECKER O.D.
Provider Business Mailing Address
First Line : 20120 PINEBROOK BLVD
Second Line :
City : BEND
State : OR
Zip : 97702-2537
Country : US
Telephone Number : 541-389-2658
Fax Number :
Provider Business Practice Location Address
First Line : 20120 PINEBROOK BLVD
Second Line :
City : BEND
State : OR
Zip : 97702-2537
Country : US
Telephone Number : 541-389-2658
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 03/02/2012

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Directions to “ MISS TONI MAE DECKER O.D.” Practice Location

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