Bay Optical Laboratory Corp.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

BAY OPTICAL LABORATORY CORP.

Practice address

3587 Broadway St
North Bend, OR 97459-1251

Phone

(541) 756-2571

Fax

(541) 756-3976

NPI assigned

Jun 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lily M. Van Elsberg

Title

Assistant Manager/Bookkeeper

Phone

(541) 756-2571

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brandon Harr

  • Optometrist
  • North Bend, OR
  • NPI 1457904963

  Single Specialty

  NPD
• Jon Kintner, M.D.

  • Ophthalmology Physician
  • North Bend, OR
  • NPI 1437150265
  NPD (past)
• Dennis E. Ottemiller, M.D.

  • Ophthalmology Physician
  • Poulsbo, WA
  • NPI 1649271487
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1407898026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3587 BROADWAY ST",
            "city": "NORTH BEND",
            "state": "OR",
            "postal_code": "974591251",
            "telephone_number": "541-756-2571",
            "fax_number": "541-756-3976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3587 BROADWAY ST",
            "city": "NORTH BEND",
            "state": "OR",
            "postal_code": "974591251",
            "telephone_number": "541-756-2571",
            "fax_number": "541-756-3976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY OPTICAL LABORATORY CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "VAN ELSBERG",
        "authorized_official_first_name": "LILY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "ASSISTANT MANAGER/BOOKKEEPER",
        "authorized_official_telephone_number": "541-756-2571"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012641",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "0009759000",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bay Area First Step, Inc.
• Bay Area Hospital District
• Bay Area Properties, LLC
• Bay Cities Medical Supply. Inc.
• Bay Eye Clinic P.C.
• Baycrest Estates, LLC
• Beacon Health Care Solutions Incorporated
• Beacon Health Care Solutions Incorporated
• Tamara Beardsley
• Julie Ann Bearup Wyatt

• Eyewear Supplier in North Bend, OR
• Providers in North Bend, OR by specialty
• Eyewear Supplier in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.