| |
315 S Pacific Hwy 99, Cottage Grove, OR 97424-2137 | |
(541) 942-0176 | |
(541) 942-0177 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 315 S Pacific Hwy 99, Cottage Grove, Oregon |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1063609063 | NPI | - | NPPES |
208414 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 2529ATI (Oregon) | Primary |
Mailing Address | Practice Location Address |
---|---|
Po Box 626, Cottage Grove, OR 97424-0027 Ph: (541) 942-0176 | 315 S Pacific Hwy 99, Cottage Grove, OR 97424-2137 Ph: (541) 942-0176 |
Mark Gotcher, O.D. Optometrist Medicare: Medicare Enrolled Practice Location: 315 S Pacific Hwy 99, Cottage Grove, OR 97424 Phone: 541-942-0176 Fax: 541-942-0177 |