| NPI | 1013964113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE W MADSEN Owner 541-926-5848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2023-04-01 |