Jennifer Carol Prunty, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3436AT Issued in OR

Practice address

300 N Graham St
Suite 300
Portland, OR 97227-1683

Phone

(503) 413-3030

Fax

(503) 413-3113

NPI assigned

Aug 20, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Jennifer Carol Sinclair Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1282262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405900800000",
    "number": "1164738795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4202 SW CORBETT AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394259",
            "telephone_number": "734-812-6186",
            "fax_number": "503-413-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N GRAHAM ST",
            "address_2": "SUITE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271683",
            "telephone_number": "503-413-3030",
            "fax_number": "503-413-3113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUNTY",
        "first_name": "JENNIFER",
        "middle_name": "CAROL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-20",
        "last_updated": "2014-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 4547",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3436AT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "SINCLAIR",
            "middle_name": "CAROL",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jill Elizabeth Pruett, MD
• Laura Pruett, PHARM.D.
• Andre B Pruitt, PH.D., MSW
• Joseph David Pruitt
• Genevieve Pruneau, PHD
• William J Prunty, OD
• Kristina Marie Prus, M.D.
• Rachel Beth Prusak, FNP
• Kara Prussing, MD
• Brian Paul Prusynski

• 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 Jul 21, 2014; 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.