NPIMap

Organization Active NPI

Sunset Eye Clinic LLC

  • Optometrist
  • Beaverton, OR
National Provider Identifier
1174549364
Registry record updated Apr 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2877ATI Issued in OR
Legal business name
SUNSET EYE CLINIC LLC
Practice address
1865 NW 169TH PL
Suite 105
Beaverton, OR 97006-7327
Phone
(503) 533-8441
Fax
(503) 533-8403
NPI assigned
Jul 14, 2006
Last updated
Apr 28, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2009

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

Authorized official

Name
Dr. Kenny B Lee, ODNPI 1619905866
Title
Partner
Phone
(503) 533-8441

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2877ATI OR Primary

Addresses

Primary practice location

1865 NW 169TH PL
Suite 105
Beaverton, OR 97006-7327

Mailing address

1865 NW 169TH PL
Suite 105
Beaverton, OR 97006-7327
Phone (503) 533-8441

Other identifiers 1

IdentifierTypeStateIssuer
270841MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090619000298 OR Part B Supplier - Clinic/Group Practice 3678624301 Receives reassigned benefits from 6 practitioners
Practice locations: Beaverton, OR
O20241122003182 OR DME Supplier - Physician - Optometrist 3678624301 Practice locations: Beaverton, OR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Sunset Eye Clinic1865 NW 169TH PL, Beaverton, OR 97006-7310(503) 533-8441 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since May 19, 2009

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240876800000",
    "number": "1174549364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1865 NW 169TH PL",
            "address_2": "SUITE 105",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970067327",
            "telephone_number": "503-533-8441",
            "fax_number": "503-533-8403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1865 NW 169TH PL",
            "address_2": "SUITE 105",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970067327",
            "telephone_number": "503-533-8441",
            "fax_number": "503-533-8403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNSET EYE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2009-04-28",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "503-533-8441",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2877ATI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270841",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.