NPIMap

Organization Active NPI

Medical Eye Center Inc

  • Ophthalmology Physician
  • Medford, OR
National Provider Identifier
1609944347
Registry record updated Jul 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MEDICAL EYE CENTER INC
Practice address
1333 E Barnett Rd
Medford, OR 97504-8219
Phone
(541) 779-4711
Fax
(541) 618-1485
NPI assigned
Dec 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2017

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

Authorized official

Name
Keith Casebolt
Title
Ceo
Phone
(541) 779-4711

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

1333 E Barnett Rd
Medford, OR 97504-8219

Mailing address

1333 E Barnett Rd
Medford, OR 97504-8219
Phone (541) 779-4711

Other identifiers 2

IdentifierTypeStateIssuer
181860972OtherRAILROAD MEDICARE
212605MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040421000753 OR Part B Supplier - Clinic/Group Practice 8325034804 Receives reassigned benefits from 18 practitioners
Practice locations: Grants Pass, OR; Medford, OR

National Provider Directory

National Provider Directory

Locations

2727 E Barnett Rd
Medford, OR 97504
Phone (503) 779-4711

1311 E Barnett Rd
Ste 301
Medford, OR 97504

221 W Stewart Ave
Ste 110
Medford, OR 97501
Phone (541) 776-9026

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501027200000",
    "number": "1609944347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 E BARNETT RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048219",
            "telephone_number": "541-779-4711",
            "fax_number": "541-618-1485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 E BARNETT RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048219",
            "telephone_number": "541-779-4711",
            "fax_number": "541-618-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL EYE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2017-07-26",
        "status": "A",
        "authorized_official_last_name": "CASEBOLT",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-779-4711"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "181860972",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "212605",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.