Provider Demographics
NPI:1447232434
Name:MEDFORD FAMILY OPTICAL
Entity Type:Organization
Organization Name:MEDFORD FAMILY OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:APOSTOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-773-7420
Mailing Address - Street 1:815 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7133
Mailing Address - Country:US
Mailing Address - Phone:541-773-7420
Mailing Address - Fax:541-779-0787
Practice Address - Street 1:815 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7133
Practice Address - Country:US
Practice Address - Phone:541-773-7420
Practice Address - Fax:541-779-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR016910Medicaid
OROR7166OtherEYEMED ID NUMBER
OR0672030001Medicare NSC