Blake Gordon Powell, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

6309 Issued in OH

Practice address

3975 Navarre Ave
Oregon, OH 43616-3437

Phone

(419) 698-4949

Fax

(419) 698-9948

NPI assigned

Jun 12, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Optometry

Education

Ohio State University - College of Optometry, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Powell Vision Clinic LLCGroup PAC ID 9739460866, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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 and National Provider Directory roles.

• Powell Vision Clinic, LLC

  • Optometrist
  • Oregon, OH
  • NPI 1861938524
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1402531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402531200000",
    "number": "1174937619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3975 NAVARRE AVE",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163437",
            "telephone_number": "419-698-4949",
            "fax_number": "419-698-9948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3975 NAVARRE AVE",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163437",
            "telephone_number": "419-698-4949",
            "fax_number": "419-698-9948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWELL",
        "first_name": "BLAKE",
        "middle_name": "GORDON",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-12",
        "last_updated": "2014-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "6309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adrienne Pontius, PA-C
• Shameka Poole, RN
• Antonio Porter
• Powell Vision Clinic, LLC
• Powell Vision Clinic, LLC
• Kim Gordon Powell, O.D.
• Lynette Sue Powell, O.D.
• Mary Frances Powers, R.PH., PH.D.
• Premise Health of Ohio Medical PA
• Erica Pribis, MD

• Optometrist in Oregon, OH
• Providers in Oregon, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2014; 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.
• 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.