NPIMap

Organization Active NPI

Keizer Vision Source PC

Doing business as Keizer Vision Clinic

  • Optometrist
  • Keizer, OR
National Provider Identifier
1083690655
Registry record updated Mar 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
KEIZER VISION SOURCE PC
Doing business as
Keizer Vision Clinic
Practice address
4350 Cherry Ave NE
Keizer, OR 97303-4855
Phone
(503) 393-6060
Fax
(503) 393-5096
NPI assigned
Dec 15, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2012

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

Authorized official

Name
Dr. Cynthia S Strawn, ODNPI 1821074493
Title
President
Phone
(503) 393-6060

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

4350 Cherry Ave NE
Keizer, OR 97303-4855

Mailing address

4350 Cherry Ave NE
Keizer, OR 97303-4855
Phone (503) 393-6060

Other names 1

  • Keizer Vision Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050822001371 OR Part B Supplier - Clinic/Group Practice 0244261014 Receives reassigned benefits from 2 practitioners
Practice locations: Keizer, OR
O20100930099891 OR DME Supplier - Physician - OptometristDME Supplier - Optician 0244261014 Practice locations: Keizer, OR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Keizer Vision Source4350 Cherry Ave NE, Keizer, OR 97303-4855(503) 393-6060 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Does not accept assignmentParticipating since Mar 28, 2005

National Provider Directory

National Provider Directory

Locations

4350 Cherry Ave NE
Keizer, OR 97303
Phone (503) 393-6060

4350 Cherry Ave NE
#A
Keizer, OR 97303
Phone (503) 393-6060

4350 Cherry Ave NE
Ste A
Keizer, OR 97303

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331164800000",
    "number": "1083690655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4350 CHERRY AVE NE",
            "city": "KEIZER",
            "state": "OR",
            "postal_code": "973034855",
            "telephone_number": "503-393-6060",
            "fax_number": "503-393-5096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 CHERRY AVE NE",
            "city": "KEIZER",
            "state": "OR",
            "postal_code": "973034855",
            "telephone_number": "503-393-6060",
            "fax_number": "503-393-5096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEIZER VISION SOURCE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-15",
        "last_updated": "2012-03-08",
        "status": "A",
        "authorized_official_last_name": "STRAWN",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-393-6060",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keizer Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Keizer, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.