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General NPI Number Information
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NPI Number | 1598940082
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Entity Type | Organization
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Legal Business Name | ROBERT W CREED OD PC
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 09/29/2008
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Provider Practice Location Address
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Address Line | 2424 SHASTA WAY
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-4354
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Country | US
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Telephone | 541-882-2812
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Fax | 541-882-5075
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Provider Business Mailing Address
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Address Line | 2424 SHASTA WAY
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-4354
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Country | US
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Telephone | 541-882-2812
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Fax | 541-882-5075
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT W. CREED
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Credential | O.D.
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Telephone | 541-882-2812
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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 | 1756T
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License Number State | OR
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