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General NPI Number Information
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NPI Number | 1407898026
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Entity Type | Organization
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Legal Business Name | BAY OPTICAL LABORATORY CORP.
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 3587 BROADWAY ST
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City | NORTH BEND
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State | OR
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Zip | 97459-1251
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Country | US
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Telephone | 541-756-2571
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Fax | 541-756-3976
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Provider Business Mailing Address
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Address Line | 3587 BROADWAY ST
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City | NORTH BEND
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State | OR
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Zip | 97459-1251
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Country | US
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Telephone | 541-756-2571
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Fax | 541-756-3976
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Authorized Official
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Title or Position | ASSISTANT MANAGER/BOOKKEEPER
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Name | LILY M. VAN ELSBERG
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Credential |
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Telephone | 541-756-2571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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