Urban Eye Gallery, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

3195 ATI Issued in OR

Legal business name

URBAN EYE GALLERY, LLC

Practice address

921 SW 16TH Ave
Portland, OR 97205-1730

Phone

(503) 227-0573

NPI assigned

Jun 7, 2013

Organization subpart

No

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

Authorized official

Name

Anita (Annie) Phromsivarak BaconNPI 1366583684

Title

Optometrist and Owner

Phone

(503) 227-0573

Specialties & licenses 1

Addresses

Other names 1

• Eye Department Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 2

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

• Anita (Annie) Phromsivarak Bacon, O.D.

  • Optometrist
  • Portland, OR
  • NPI 1366583684
  Medicare reassignment Care Compare group NPD Authorized official
• Katlyn Rene Peterson, OD

  • Optometrist
  • Portland, OR
  • NPI 1538768007
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1370563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787788800000",
    "number": "1124466545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 SW 16TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051730",
            "telephone_number": "503-227-0573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 SW 16TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051730",
            "telephone_number": "503-227-0573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URBAN EYE GALLERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-07",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A",
        "authorized_official_last_name": "BACON",
        "authorized_official_first_name": "ANITA (ANNIE)",
        "authorized_official_middle_name": "PHROMSIVARAK",
        "authorized_official_title_or_position": "OPTOMETRIST AND OWNER",
        "authorized_official_telephone_number": "503-227-0573"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3195 ATI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rakhee Nandkumar Urankar, MD.
• Elena Uranwala
• Walter John Urba, MD, PHD
• Daniel J. Urbach, MD
• Adam Lyle Urback, MD, MS
• Urban Wellness Group LLC
• Angelmary Urban
• Jenna Urban
• Phaedra Ann Urban
• Anna Urbanc, PA-C

• Optometrist in Portland, OR
• Providers in Portland, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2026; 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.