Individual provider Active NPI

Tina Diem Vuong

  • Optometrist
  • Forest Grove, OR
National Provider Identifier
1053109983
Registry record updated Aug 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ATI4792 Issued in OR
Practice address
2043 College Way
Forest Grove, OR 97116-1797
Phone
(503) 352-6151
NPI assigned
Apr 29, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Optometrist 152W00000X ATI4792 OR Primary

Addresses

Primary practice location

2043 College Way
Forest Grove, OR 97116-1797

Mailing address

2225 NE 88TH Ave
Portland, OR 97220-5430

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260523000260 OR Practitioner - Optometry 6709351463

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sterling Vision PCGroup PAC ID 3173773694, 9 clinicians

Practice addresses (Care Compare)

1594 Edgewater St NW
Suite 190
Salem, OR 97304-4656
Phone (541) 762-2763

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ATI4792ORMDOptometrist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1745884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755302400000",
    "number": "1053109983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 NE 88TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972205430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2043 COLLEGE WAY",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971161797",
            "telephone_number": "503-352-6151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VUONG",
        "first_name": "TINA",
        "middle_name": "DIEM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-04-29",
        "last_updated": "2025-08-16",
        "certification_date": "2025-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "ATI4792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Grove, OR

Sources for this page

Verify at the official NPI Registry.