| |
425 N Main St, Myrtle Creek, OR 97457-0056 | |
(541) 863-5258 | |
(541) 863-6000 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 425 N Main St, Myrtle Creek, Oregon |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1548439185 | NPI | - | NPPES |
22617-5 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 1481ATI (Oregon) | Primary |
Provider Name | Lynn Goodwin |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1407968472 PECOS PAC ID: 0042398638 Enrollment ID: I20080423000083 |
Provider Name | Makayla Renae Adams |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1790461911 PECOS PAC ID: 4789044322 Enrollment ID: I20230714001189 |
Mailing Address | Practice Location Address |
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Po Box 6006, Myrtle Creek, OR 97457-0056 Ph: (541) 863-5258 | 425 N Main St, Myrtle Creek, OR 97457-0056 Ph: (541) 863-5258 |
Mr. Lynn E Goodwin, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 425 N Main, Myrtle Creek, OR 97457 Phone: 541-863-5258 Fax: 541-863-6000 | |
Makayla Adams, OD Optometrist Medicare: Medicare Enrolled Practice Location: 425 N Main St, Myrtle Creek, OR 97457 Phone: 541-863-5258 |