Individual provider Active NPI

Yuesum To, OD

  • Optometrist
  • Portland, OR
National Provider Identifier
1144324732
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3153T Issued in OR
Practice address
3333 SE Belmont St
Portland, OR 97214-4244
Phone
(503) 335-7173
Fax
(503) 335-7973
NPI assigned
Sep 12, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3153T OR Primary
Optometrist 152W00000X 10865T CA

Addresses

Primary practice location

3333 SE Belmont St
Portland, OR 97214-4244

Mailing address

2368 W Burnside St
Portland, OR 97210-3538
Phone (503) 830-0265

Other names 1

  • Summy To Other name

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
I20070921000534 OR Practitioner - Optometry 6103910021 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myoptic Optometry, LLCGroup PAC ID 4183719701, 6 clinicians

Practice addresses (Care Compare)

3978 N Williams Ave
Portland, OR 97227-1445
Phone (503) 493-7070

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10865TCAMDOptometrist
3153TORMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myoptic Optometry, LLC CurrentSince Sep 27, 2007 Accepting new patients

Locations

8046 SE 13th Ave
Portland, OR 97202
Phone (503) 420-8689

3333 SE Belmont St
Portland, OR 97214
Phone (503) 335-7173

12 SE 28th Ave
Portland, OR 97214
Phone (503) 282-2020

3978 N Williams Ave
Portland, OR 97227
Phone (503) 493-7070

Organizations & group practices 1

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": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144324732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2368 W BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103538",
            "telephone_number": "503-830-0265",
            "fax_number": "503-335-7973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 SE BELMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144244",
            "telephone_number": "503-335-7173",
            "fax_number": "503-335-7973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TO",
        "first_name": "YUESUM",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3153T",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10865T",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUMMY",
            "last_name": "TO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.