MEDICARE: DR. IAN ODGEAR AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	030857	OR

General Provider Information

NPI Number	:	1225488786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IAN ODGEAR AU.D.

Provider Business Mailing Address
First Line	:	2205 NW SHEVLIN PARK RD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-7195
Country	:	US
Telephone Number	:	541-678-5698
Fax Number	:

Provider Business Practice Location Address
First Line	:	2205 NW SHEVLIN PARK RD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-7195
Country	:	US
Telephone Number	:	541-678-5698
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	06/15/2016

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