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General NPI Number Information
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NPI Number | 1063722866
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Entity Type | Individual
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Provider Name | KORBIN JAMES KOCH O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 3600 WASHBURN WAY WALMART VISION CENTER
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City | KLAMATH FALLS
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State | OR
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Zip | 97603-4539
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Country | US
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Telephone | 541-885-5405
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Fax | 541-883-1158
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Provider Business Mailing Address
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Address Line | PO BOX 7428
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City | KLAMATH FALLS
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State | OR
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Zip | 97602-0428
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Country | US
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Telephone | 541-885-5405
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Fax | 541-883-1158
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3495ATI
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License Number State | OR
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