Provider Demographics
NPI:1730148271
Name:KLAMATH OPHTHALMOLOGY PC
Entity type:Organization
Organization Name:KLAMATH OPHTHALMOLOGY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:2640 BIEHN ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1181
Mailing Address - Country:US
Mailing Address - Phone:541-884-3148
Mailing Address - Fax:541-884-3373
Practice Address - Street 1:2640 BIEHN ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1181
Practice Address - Country:US
Practice Address - Phone:541-884-3148
Practice Address - Fax:541-884-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2714AT152W00000X
OR1333T152W00000X
OR2975T152W00000X
ORMD16253207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCO1675OtherRAILROAD MEDICARE
OR004571000OtherBCBS
OR096255Medicaid
ORCK5472OtherRAILROAD MEDICARE
OR0447820002Medicare NSC
ORR0000WCHMLMedicare PIN
ORR113511Medicare PIN
ORCK5472OtherRAILROAD MEDICARE