Madras Vision Source PC

Optometrist · Madras, OR

Organization Active NPI

NPI number 1164791414

Practice location

211 SE 5TH St
Madras, OR 97741
Phone
(541) 475-2020
Fax
(541) 475-6118

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NPI record

NPI
1164791414
Entity type
Organization (Type 2)
Enumeration date
December 15, 2011
Last updated
May 17, 2022
Certified
May 17, 2022
Organization subpart
Yes
Parent organization
Madras Vision Source PC

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Optometrist Primary 152W00000X 3215ATI OR
Eyewear Supplier 332H00000X — —

Authorized official

Name
Jessica Brooke Tegan, OD
Title
Owner
Phone
(541) 475-2020

Other names

  • Madras Vision Source LLC

About Madras Vision Source PC

Madras Vision Source PC is a healthcare organization registered in the NPI registry with the primary taxonomy Optometrist (code 152W00000X). The practice location is 211 SE 5TH St, Madras, OR 97741. The NPI number 1164791414 was assigned on December 15, 2011 and the record was last updated on May 17, 2022.

Madras Vision Source PC lists a license in the registry: #3215ATI (OR) for Optometrist. License numbers are self-reported to NPPES; verify them with the state licensing board.

The authorized official for this organization is Jessica Brooke Tegan, OD, Owner.

Frequently asked questions

What is the NPI number of Madras Vision Source PC?

The NPI number is 1164791414.

What is the phone number of Madras Vision Source PC?

The phone number listed for the practice location is (541) 475-2020.

Where is Madras Vision Source PC located?

211 SE 5TH St, Madras, OR 97741.

What is the taxonomy code for Madras Vision Source PC?

The primary taxonomy code is 152W00000X – Optometrist; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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