Timothy Allen Speck, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3631ATI Issued in OR

Practice address

2144 Hawthorne St
Apt 56
Forest Grove, OR 97116-1749

Phone

(217) 416-9452

NPI assigned

Oct 10, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444262400000",
    "number": "1093067324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 NE 69TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972135302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2144 HAWTHORNE ST",
            "address_2": "APT 56",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971161749",
            "telephone_number": "217-416-9452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPECK",
        "first_name": "TIMOTHY",
        "middle_name": "ALLEN",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-10",
        "last_updated": "2015-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3631ATI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelvin Kiu Wing So, O.D.
• Jaclyn Sorbets
• Paul E Sorenson, LCSW
• Karen Anne Sotto, L.M.T.
• Jamison Riley Soupir, OD
• Emily Anne Sproul, MS CCC-SLP
• Paige Elise Stahle
• Stephanie Haugen LLC
• Sean Lincoln Steward, MD
• Valarie Joyce Stewart

• Optometrist in Forest Grove, OR
• Providers in Forest Grove, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.