Individual provider Active NPI

Robert Wesley Creed, O.D.

  • Optometrist
  • Klamath Falls, OR
National Provider Identifier
1174616163
Registry record updated Sep 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1756ATI Issued in OR
Practice address
2424 Shasta Way
Klamath Falls, OR 97601-4354
Phone
(541) 882-2812
Fax
(541) 882-5075
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1756ATI OR Primary

Addresses

Primary practice location

2424 Shasta Way
Klamath Falls, OR 97601-4354

Mailing address

2424 Shasta Way
Klamath Falls, OR 97601-4354
Phone (541) 882-2812

Other identifiers 1

IdentifierTypeStateIssuer
034780MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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 1

Enrollment IDStateProvider typePAC IDDetails
I20101213001034 OR Practitioner - Optometry 1254409022 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alex Hutzell OD PCGroup PAC ID 6103283122, 2 clinicians

Practice addresses (Care Compare)

2424 Shasta Way
Klamath Falls, OR 97601-4354
Phone (541) 882-2812

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Alex Hutzell, O.D.,P.C. Optometrist CurrentSince Aug 26, 2023 Accepting new patients

Locations

2424 Shasta Way
Klamath Falls, OR 97601
Phone (541) 882-2812

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220313600000",
    "number": "1174616163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2424 SHASTA WAY",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976014354",
            "telephone_number": "541-882-2812",
            "fax_number": "541-882-5075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424 SHASTA WAY",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976014354",
            "telephone_number": "541-882-2812",
            "fax_number": "541-882-5075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CREED",
        "first_name": "ROBERT",
        "middle_name": "WESLEY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2008-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1756ATI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "034780",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Klamath Falls, OR

Sources for this page

Verify at the official NPI Registry.