Kevin Gia-Minh Phan, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4708 Issued in OR

Practice address

12000 SE 82ND Ave Ste 2193
Happy Valley, OR 97086-7746

Phone

(503) 654-6217

Fax

(503) 654-9335

NPI assigned

Oct 24, 2019

Last updated

Sep 12, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA, OR2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pacific Eye Group, PC

  • Optometrist
  • Bend, OR
  • NPI 1831656925

  WA

  Medicare reassignment NPD
• Charles Sung MD PC

  dba Retina Laser Eye Center

  • Ophthalmology Physician
  • Kennewick, WA
  • NPI 1245358050
  Medicare reassignment NPD

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

{
    "created_epoch": "1571875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1164065959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11084 SE 64TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972222319",
            "telephone_number": "503-890-7209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 SE 82ND AVE STE 2193",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970867746",
            "telephone_number": "503-654-6217",
            "fax_number": "503-654-9335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "KEVIN",
        "middle_name": "GIA-MINH",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-24",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "60964432",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "4708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peaceful Care House
• Peacehealth Networks on Demand, LLC (ZoomCare Happy Valley)
• Anna Christine Peaslee
• Adam Peterson, QMHP
• Heather Peterson
• Graham A Phelps, FNP-BC
• Crissy K Phommachack
• Physical Therapy Specialists (Mt Scott Physical Therapy)
• Physiotherapy Associates Inc. (Select Physical Therapy)
• Lizette C Picasso, MSNE, MSED

• Optometrist in Happy Valley, OR
• Providers in Happy Valley, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.