Provider Demographics
NPI:1972506087
Name:PHILIP PADEN EYE CARE CENTER M D
Entity type:Organization
Organization Name:PHILIP PADEN EYE CARE CENTER M D
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PADEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-776-9026
Mailing Address - Street 1:221 STEWART AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501
Mailing Address - Country:US
Mailing Address - Phone:541-776-9026
Mailing Address - Fax:541-776-9096
Practice Address - Street 1:221 STEWART AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501
Practice Address - Country:US
Practice Address - Phone:541-776-9026
Practice Address - Fax:541-776-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13653207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD73003Medicare UPIN
OR112566Medicare ID - Type Unspecified