Provider Demographics
NPI:1780234435
Name:MEDFORD GROUP EYECARE INCORPORATED
Entity type:Organization
Organization Name:MEDFORD GROUP EYECARE INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:OBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-773-7273
Mailing Address - Street 1:1430 E MCANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6170
Mailing Address - Country:US
Mailing Address - Phone:541-772-7273
Mailing Address - Fax:
Practice Address - Street 1:1430 E MCANDREWS RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6170
Practice Address - Country:US
Practice Address - Phone:541-772-7273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-15
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty