Forest Grove Medical PC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

FOREST GROVE MEDICAL PC

Practice address

2804 19TH Ave
Forest Grove, OR 97116-2625

Phone

(503) 357-2020

Fax

(503) 357-6995

NPI assigned

Jan 11, 2012

Last updated

Jan 11, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brad C Richardson, ODNPI 1922009836

Title

President

Phone

(503) 357-2020

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

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.

• Brad C Richardson, O.D.

  • Optometrist
  • Forest Grove, OR
  • NPI 1922009836
  Medicare reassignment NPD Authorized official
• Jessica Richardson, AU.D.

  • Audiologist
  • Forest Grove, OR
  • NPI 1982956538
  NPD (past)

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

{
    "created_epoch": "1326240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326240000000",
    "number": "1154691830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 38",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971160038",
            "telephone_number": "503-357-2020",
            "fax_number": "503-357-6995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2804 19TH AVE",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971162625",
            "telephone_number": "503-357-2020",
            "fax_number": "503-357-6995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST GROVE MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-11",
        "last_updated": "2012-01-11",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-357-2020",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl Lee Fletcher
• Sarah Elizabeth Foidel, OTR/L
• Forest Grove Chiropractic LLC
• Forest Grove Family Eye Care, P.C.
• Forest Grove Kids' Dentist, LLC
• Forest Grove Pediatrics PC
• Forest Grove SNF Healthcare LLC (Forest Grove Post Acute)
• Charlotte Forgie, O.D.
• John Edward Forsyth Jr., D.M.D.
• Ninette Kay Foster, LMT

• 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 Jan 11, 2012; 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.