Provider Demographics
NPI:1245256445
Name:BAILEY, JAMES TROY (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:TROY
Last Name:BAILEY
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 1:519 W NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828
Mailing Address - Country:US
Mailing Address - Phone:541-426-3413
Mailing Address - Fax:541-426-4489
Practice Address - Street 1:519 W NORTH STREET
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828
Practice Address - Country:US
Practice Address - Phone:541-426-3413
Practice Address - Fax:541-426-4489
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2557T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275377Medicaid
OR275377Medicaid
ORR167757Medicare PIN