Provider Demographics
NPI:1588720031
Name:CHESLOCK, JAMES PATRICK (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
Last Name:CHESLOCK
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 1:1817 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3442
Mailing Address - Country:US
Mailing Address - Phone:541-756-2727
Mailing Address - Fax:541-756-7064
Practice Address - Street 1:1817 MEADE ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-3442
Practice Address - Country:US
Practice Address - Phone:541-756-2727
Practice Address - Fax:541-756-7064
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1820ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR143693Medicaid
OR3542160001Medicare NSC
OR143693Medicaid
ORT67506Medicare UPIN