Provider Demographics
NPI:1902041676
Name:KLAMATH OPHTHALMOLOGY PC
Entity Type:Organization
Organization Name:KLAMATH OPHTHALMOLOGY PC
Other - Org Name:DOWNTOWN OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-884-3148
Mailing Address - Street 1:629 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6007
Mailing Address - Country:US
Mailing Address - Phone:541-884-8322
Mailing Address - Fax:541-884-7121
Practice Address - Street 1:629 MAIN ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6007
Practice Address - Country:US
Practice Address - Phone:541-884-8322
Practice Address - Fax:541-884-7121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KLAMATH OPHTHALMOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-10
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2975ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR272364Medicaid
ORCK5472OtherRAILROAD MEDICARE
OR272364Medicaid
ORR113511Medicare PIN