Individual provider Active NPI

William J Prunty, OD

  • Optometrist
  • Portland, OR
National Provider Identifier
1184734394
Registry record updated Apr 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3825 Issued in FL
Practice address
3710 SW US Veterans Hospital Rd
Portland, OR 97239-2964
Phone
(503) 220-8262
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3825 FL Primary
Optometrist 152W00000X 06478T TX

Addresses

Primary practice location

3710 SW US Veterans Hospital Rd
Portland, OR 97239-2964

Mailing address

14597 SW 81St Ave
Tigard, OR 97224-7355
Phone (281) 703-4722

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
I20130711000285 OR Order and Referring Only - OptometryPractitioner - Optometry 1153561311

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3825FLMDOptometrist
06478TTXMDOptometrist
6478ORMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367280000000",
    "number": "1184734394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14597 SW 81ST AVE",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247355",
            "telephone_number": "281-703-4722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3710 SW US VETERANS HOSPITAL RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972392964",
            "telephone_number": "503-220-8262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUNTY",
        "first_name": "WILLIAM",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2013-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "3825",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "06478T",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.