Provider Demographics
NPI:1366689937
Name:ASHLAND'S OPTICAL EXPRESSIONS, PC
Entity Type:Organization
Organization Name:ASHLAND'S OPTICAL EXPRESSIONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:EHLERS
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:541-488-0320
Mailing Address - Street 1:30 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2726
Mailing Address - Country:US
Mailing Address - Phone:541-488-0320
Mailing Address - Fax:541-552-9667
Practice Address - Street 1:30 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2726
Practice Address - Country:US
Practice Address - Phone:541-488-0320
Practice Address - Fax:541-552-9667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1422T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1487682449OtherNPI
ORR145717Medicare PIN