Provider Demographics
NPI:1104368216
Name:OBERLY, TAYLOR SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:SCOTT
Last Name:OBERLY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 CHANNELWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:IN
Mailing Address - Zip Code:46506-9391
Mailing Address - Country:US
Mailing Address - Phone:574-276-1965
Mailing Address - Fax:
Practice Address - Street 1:1430 E MCANDREWS RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6170
Practice Address - Country:US
Practice Address - Phone:541-772-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1955152W00000X
ORAT4482152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist