Basic Information
| Provider Information | |||||||||
| NPI: | 1285685032 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEMLEY | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | AUGUSTUS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 E BARNETT RD | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417794711 | ||||||||
| FaxNumber: | 5416181485 | ||||||||
| Practice Location | |||||||||
| Address1: | 1333 E BARNETT RD | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417794711 | ||||||||
| FaxNumber: | 5416181485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 05/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 47815 | WI | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | MD27331 | OR | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | MD00042766 | WA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0107X | MD27331 | OR | Y |
ID Information
| ID | Type | State | Issuer | Description | 272436 | 05 | OR | MEDICAID | 007806261R | 01 | HUMANA | OTHER |