NPIMap

Organization Active NPI

Eyecare Associates of Southern Oregon PC

  • Optometrist
  • Medford, OR
National Provider Identifier
1902981087
Registry record updated Jun 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3079AT Issued in OR
Legal business name
EYECARE ASSOCIATES OF SOUTHERN OREGON PC
Practice address
935 Royal Ave
Medford, OR 97504-6140
Phone
(541) 779-2211
Fax
(541) 779-8778
NPI assigned
Oct 26, 2006
Last updated
Jun 16, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2011

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

Authorized official

Name
Mr. Brian K Mitchell, O. D.NPI 1417998006
Title
President
Phone
(541) 779-2211

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3079AT OR Primary

Addresses

Primary practice location

935 Royal Ave
Medford, OR 97504-6140

Mailing address

935 Royal Ave
Medford, OR 97504-6140
Phone (541) 779-2211

Other identifiers 3

IdentifierTypeStateIssuer
064886MedicaidOR
026488MedicaidOR
229948MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040122000824 OR Part B Supplier - Clinic/Group Practice 9032011838 Receives reassigned benefits from 4 practitioners
Practice locations: Medford, OR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308182400000",
    "number": "1902981087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 ROYAL AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046140",
            "telephone_number": "541-779-2211",
            "fax_number": "541-779-8778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 ROYAL AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046140",
            "telephone_number": "541-779-2211",
            "fax_number": "541-779-8778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE ASSOCIATES OF SOUTHERN OREGON PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2011-06-16",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-779-2211",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "O. D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3079AT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "064886",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026488",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "229948",
            "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 Jun 16, 2011; 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.