Healthcare Provider Details

I. General information

NPI: 1447232434
Provider Name (Legal Business Name): MEDFORD FAMILY OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E MAIN ST
MEDFORD OR
97504-7133
US

IV. Provider business mailing address

815 E MAIN ST
MEDFORD OR
97504-7133
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-7420
  • Fax: 541-779-0787
Mailing address:
  • Phone: 541-773-7420
  • Fax: 541-779-0787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN G APOSTOL
Title or Position: OWNER
Credential: M.D.
Phone: 541-773-7420