MEDICARE: PHILIP PADEN EYE CARE CENTER M 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
1	207W00000X	Ophthalmology Physician	13653	OR

General Provider Information

NPI Number	:	1972506087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILIP PADEN EYE CARE CENTER M D

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

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

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	PHILIP Y PADEN
Credential	:	M.D.
Telephone Number	:	541-776-9026

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	01/11/2012

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