Provider Demographics
NPI:1851860621
Name:RETINA & VITREOUS CENTER OF SOUTHERN OREGON, PC
Entity Type:Organization
Organization Name:RETINA & VITREOUS CENTER OF SOUTHERN OREGON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:RODDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-488-3192
Mailing Address - Street 1:246 CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1624
Mailing Address - Country:US
Mailing Address - Phone:541-488-3192
Mailing Address - Fax:541-488-0646
Practice Address - Street 1:3516 EXCEL DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9750
Practice Address - Country:US
Practice Address - Phone:541-488-3192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty