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General NPI Number Information
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NPI Number | 1811962103
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Entity Type | Organization
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Legal Business Name | SALEM OR OPHTHALMOLOGY ASC LLC
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 1330 COMMERCIAL ST SE
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City | SALEM
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State | OR
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Zip | 97302-4206
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Country | US
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Telephone | 503-763-1973
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Fax | 503-763-8886
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Provider Business Mailing Address
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Address Line | 1A BURTON HILLS BLVD ATTN: L&C
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City | NASHVILLE
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State | TN
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Zip | 37215-0000
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Country | US
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Telephone | 615-665-1283
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Fax | 615-234-1720
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. KATHERINE JUDKINS
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Credential |
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Telephone | 615-665-1283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 07-1574
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License Number State | OR
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