Provider Demographics
NPI:1609944347
Name:MEDICAL EYE CENTER INC
Entity Type:Organization
Organization Name:MEDICAL EYE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEBOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-779-4711
Mailing Address - Street 1:1333 E BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8219
Mailing Address - Country:US
Mailing Address - Phone:541-779-4711
Mailing Address - Fax:541-618-1485
Practice Address - Street 1:1333 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8219
Practice Address - Country:US
Practice Address - Phone:541-779-4711
Practice Address - Fax:541-618-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
181860972OtherRAILROAD MEDICARE
OR212605Medicaid
0000WCGJJMedicare ID - Type Unspecified
OR212605Medicaid