MEDICARE: GILBERT LE CREN

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	3015ATI	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700865961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILBERT LE CREN

Provider Business Mailing Address
First Line	:	PO BOX 1367
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-0106
Country	:	US
Telephone Number	:	541-265-9458
Fax Number	:	541-265-6586

Provider Business Practice Location Address
First Line	:	111 SE DOUGLAS ST
Second Line	:	STE D
City	:	NEWPORT
State	:	OR
Zip	:	97365-4499
Country	:	US
Telephone Number	:	541-265-9458
Fax Number	:	541-265-6586

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

Provider Enumeration Date	:	01/15/2006
Last Update Date	:	05/13/2011

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Directions to “ GILBERT LE CREN ” Practice Location

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