Salem Or Ophthalmology ASC LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

07-1574 Issued in OR

Legal business name

SALEM OR OPHTHALMOLOGY ASC LLC

Doing business as

Salem Laser & Surgery Center

Practice address

1330 Commercial St SE
Salem, OR 97302-4206

Phone

(503) 763-1973

Fax

(503) 763-8886

NPI assigned

Feb 21, 2006

Last updated

Apr 14, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Katherine Judkins

Title

Vice President

Phone

(615) 665-1283

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Salem Laser & Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Listed as

Salem Laser and Surgery CenterCCN 38C0001036

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649894400000",
    "number": "1811962103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1A BURTON HILLS BLVD",
            "address_2": "ATTN: L&C",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372150000",
            "telephone_number": "615-665-1283",
            "fax_number": "615-234-1720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 COMMERCIAL ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024206",
            "telephone_number": "503-763-1973",
            "fax_number": "503-763-8886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALEM OR OPHTHALMOLOGY ASC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-21",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A",
        "authorized_official_last_name": "JUDKINS",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-665-1283",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OR",
            "license": "07-1574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005857",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Salem Laser & Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Salem Laser & Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Salem, OR
• Providers in Salem, OR by specialty
• Ambulatory Surgical Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; 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.