Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MD25921 | OR |
NPI | 1013924513 |
---|---|
Provider Name | Dr. Scott Troy O'connor |
First Address | Bend, OR 97701-6051 |
Second Address | Bend, OR 97701-6051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 11/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00411297 | MEDICARE RAILROAD (01) | OR |
269879 | (05) | OR |
H83875 | (02) | OR |