Eye Care Group of Southern Oregon, LLC
Organization Active NPI Optometrist · Cave Junction, OR
NPI 1386786309 · NPPES record last updated Jan 9, 2024
Key facts
- NPI
- 1386786309
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- EYE CARE GROUP OF SOUTHERN OREGON, LLC
- Practice address
- 335 Caves Highway
Cave Junction, OR 97523 - Phone
- (541) 592-3921
- Fax
- (541) 592-4883
- NPI assigned
- Feb 13, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Jeffrey S Pelson, OD
- Title
- Owner
- Phone
- (541) 592-3921
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 11
-
Angela Marie Dedionisio, O.D.
-
Jeffrey Scott Pelson, O.D.
-
Daniel Joseph Vidlak, O.D.
-
Jason K Bates, OD
-
Kenji Hamada, O.D.
-
Charles Richard Matti, O.D.
-
Matthew Scot Richardson, O.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Eye Care Group of Southern Oregon P |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060209000139 | OR | Part B Supplier - Clinic/Group Practice | 4082629290 |
Receives reassigned benefits from 8 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cave Junction, OR; Grants Pass, OR |
| O20100930046634 | OR | DME Supplier - Physician - Optometrist | 4082629290 | Practice locations: Cave Junction, OR |
National Provider Directory
- Tax ID family
- Eye Care Group
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
335 Caves Highway
Cave Junction, OR 97523
Mailing address
335 Caves Highway
PO Box 448
Cave Junction, OR 97523
Phone (541) 592-3921
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 005730 | Medicaid | OR |
Other names
- Eye Care Group
Other providers in Cave Junction, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.