Individual provider Active NPI

Allie De la Cruz

  • Optometrist
  • Beaverton, OR
National Provider Identifier
1063269488
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ATI4733 Issued in OR
Practice address
4655 SW Griffith Dr Ste 165
Beaverton, OR 97005-8731
Phone
(503) 646-8592
Fax
(503) 526-3989
NPI assigned
May 2, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ATI4733 OR Primary

Addresses

Primary practice location

4655 SW Griffith Dr Ste 165
Beaverton, OR 97005-8731

Mailing address

4655 SW Griffith Dr Ste 165
Beaverton, OR 97005-8731
Phone (503) 646-8592

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
I20241108001908 OR Practitioner - Optometry 7810421104 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
A New Vision PCGroup PAC ID 0749339000, 4 clinicians

Practice addresses (Care Compare)

4655 SW Griffith Dr
Suite 165
Beaverton, OR 97005-8731
Phone (503) 646-8592

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4733ORMDDentist
ATI4733ORMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
A New Vision, P.C. Optometrist CurrentSince Nov 19, 2025 Accepting new patients
Northwest Eye Care LLC Optometrist PastSince May 1, 2024 Accepting new patients
Bruce R Wojciechowski Optometrist PastSince May 1, 2024 Accepting new patients

Locations

4655 SW Griffith Dr
Ste 165
Beaverton, OR 97005
Phone (503) 646-8592

Organizations & group practices 3

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": "1714608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1063269488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4655 SW GRIFFITH DR STE 165",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970058731",
            "telephone_number": "503-646-8592",
            "fax_number": "503-526-3989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4655 SW GRIFFITH DR STE 165",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970058731",
            "telephone_number": "503-646-8592",
            "fax_number": "503-526-3989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LA CRUZ",
        "first_name": "ALLIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-02",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "ATI4733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

Verify at the official NPI Registry.