NPIMap

Organization Active NPI

Joanna M Gervais OD LLC

  • Optometrist
  • Springfield, OR
National Provider Identifier
1144556655
Registry record updated Nov 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3263AT Issued in OR
Legal business name
JOANNA M GERVAIS OD LLC
Practice address
1871 2ND St
Springfield, OR 97477-2121
Phone
(541) 741-0122
NPI assigned
Oct 19, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2009

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

Authorized official

Name
Dr. Joanna M Gervais, OD
Title
Optometrist/Owner
Phone
(541) 777-0245

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 3263AT OR Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

1871 2ND St
Springfield, OR 97477-2121

Mailing address

1871 2ND St
Springfield, OR 97477-2121
Phone (541) 741-0122

Other names 1

  • Custom Eyes Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1255910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258329600000",
    "number": "1144556655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1871 2ND ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974772121",
            "telephone_number": "541-741-0122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1871 2ND ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974772121",
            "telephone_number": "541-741-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOANNA M GERVAIS OD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-19",
        "last_updated": "2009-11-16",
        "status": "A",
        "authorized_official_last_name": "GERVAIS",
        "authorized_official_first_name": "JOANNA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "541-777-0245",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3263AT",
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Eyes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.