NPIMap

Organization Active NPI

Eye Health Northwest P.C.

  • Ophthalmology Physician
  • Milwaukie, OR
National Provider Identifier
1124353362
Registry record updated Feb 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
EYE HEALTH NORTHWEST P.C.
Practice address
11086 SE Oak St
Milwaukie, OR 97222-6692
Phone
(503) 656-4221
Fax
(503) 656-4249
NPI assigned
Oct 6, 2009
Last updated
Feb 20, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
EYE HEALTH NORTHWEST P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 20, 2021

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

Authorized official

Name
Dr. Shane K Kim, M.D.NPI 1801974027
Title
President
Phone
(503) 255-2291

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

11086 SE Oak St
Milwaukie, OR 97222-6692

Mailing address

PO Box 22009
Milwaukie, OR 97269-2009
Phone (503) 558-7372

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930047707 OR DME Supplier - Physician - General PracticeDME Supplier - Physician - Optometrist 9234039926 Practice locations: Milwaukie, OR

Other NPIs with the same Medicare PAC ID 18

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 18

National Provider Directory

National Provider Directory
Tax ID family
Eye Health Northwestpc19 organizations share this tax ID, including this one
Part of
Eye Health Northwestpc

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Locations

11086 SE Oak St
Portland, OR 97222
Phone (503) 557-2020

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1254787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613779200000",
    "number": "1124353362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22009",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972692009",
            "telephone_number": "503-558-7372",
            "fax_number": "503-344-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11086 SE OAK ST",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972226692",
            "telephone_number": "503-656-4221",
            "fax_number": "503-656-4249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE HEALTH NORTHWEST P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EYE HEALTH NORTHWEST P.C.",
        "enumeration_date": "2009-10-06",
        "last_updated": "2021-02-20",
        "certification_date": "2021-02-20",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-255-2291",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukie, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.