Healthcare Provider Details

I. General information

NPI: 1285812123
Provider Name (Legal Business Name): OREGON RETINA SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2008
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 E BARNETT RD
MEDFORD OR
97504-8281
US

IV. Provider business mailing address

1518 E BARNETT RD
MEDFORD OR
97504-8281
US

V. Phone/Fax

Practice location:
  • Phone: 541-770-2020
  • Fax: 541-200-2599
Mailing address:
  • Phone: 541-770-2020
  • Fax: 541-200-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: YUJEN WANG
Title or Position: MEMBER
Credential: MD
Phone: 541-770-2020