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NPI Code Detail

MEDICARE: DR. RAY J WEEKLY O.D.

MEDICARE:  DR. RAY J WEEKLY  O.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
1152W00000XOptometrist1966ATOR
2152W00000XOptometrist3872WA

General Provider Information

NPI Number : 1407840630
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAY J WEEKLY O.D.
Provider Business Mailing Address
First Line : 5412 KAFIR DR NE
Second Line :
City : KEIZER
State : OR
Zip : 97303-3618
Country : US
Telephone Number : 503-566-3710
Fax Number :
Provider Business Practice Location Address
First Line : 3750 CHEMAWA RD NE
Second Line : CHEMAWA HEALTH CENTER
City : SALEM
State : OR
Zip : 97305-1119
Country : US
Telephone Number : 503-304-7659
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2005
Last Update Date : 07/08/2007

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Directions to “ DR. RAY J WEEKLY O.D.” Practice Location

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