Provider Demographics
NPI:1215442702
Name:KLAMATH OPHTHALMOLOGY PC
Entity type:Organization
Organization Name:KLAMATH OPHTHALMOLOGY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE & BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLEZAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-883-3688
Mailing Address - Street 1:2615 ALMOND ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1176
Mailing Address - Country:US
Mailing Address - Phone:541-883-3688
Mailing Address - Fax:541-883-3687
Practice Address - Street 1:1201 THOMASON LN
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101-3150
Practice Address - Country:US
Practice Address - Phone:530-233-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KLAMATH OPHTHALMOLOGY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-06
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty