MEDICARE: GROUP EYECARE CENTER, LLC

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	152W00000X	Optometrist	1247ATI	OR

General Provider Information

NPI Number	:	1275787491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROUP EYECARE CENTER, LLC

Provider Business Mailing Address
First Line	:	1430 E MCANDREWS RD
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-6108
Country	:	US
Telephone Number	:	541-772-7273
Fax Number	:	541-772-4981

Provider Business Practice Location Address
First Line	:	1430 E MCANDREWS RD
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-6108
Country	:	US
Telephone Number	:	541-772-7273
Fax Number	:	541-772-4981

Authorized Official
Title or Position	:	DOCTOR/BUSINESS OWNER
Name	:	DR. GEORGE LAM
Credential	:
Telephone Number	:	541-772-7273

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	09/18/2015

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