Radebaugh, Charles Duane

Radebaugh, Charles Duane is an individual health care provider with primary practice located at 1800 Centennial Blvd Suite 2, Springfield OR 97477-4385. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Radebaugh, Charles Duane can be contacted via phone (541) 726-5055.

Contact Information

Primary practice address
1800 Centennial Blvd Suite 2 Springfield OR 97477-4385
Phone: (541) 726-5055
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1193T Oregon
Eye and Vision Services Providers / Optometrist 152W00000X 3463 Washington

Profile Details

NPI number 1710969480
LBN Legal business name Radebaugh, Charles Duane
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 17th, 2005
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710969480 NPPES
Oregon MEDICAID 167197

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