NPIMap

Organization Active NPI

Eyehealth Northwest Optical, LLC

  • Eyewear Supplier
  • Milwaukie, OR
National Provider Identifier
1194940726
Registry record updated Sep 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
EYEHEALTH NORTHWEST OPTICAL, LLC
Practice address
11086 SE Oak St
Administration
Milwaukie, OR 97222-6692
Phone
(503) 344-5102
Fax
(503) 344-5110
NPI assigned
Apr 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2008

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

Authorized official

Name
Dr. Robert Wells Bentley, MD
Title
Officer
Phone
(503) 557-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

11086 SE Oak St
Administration
Milwaukie, OR 97222-6692

Mailing address

PO Box 22009
Milwaukie, OR 97269-2009
Phone (503) 344-5102

Other identifiers 7

IdentifierTypeStateIssuer
1243050004OtherORDURABLE MEDICAL EQUIPMENT
1243050002OtherORDURABLE MEDICAL EQUIPMENT
1243050003OtherORDURABLE MEDICAL EQUIPMENT
1243050006OtherORDURABLE MEDICAL EQUIPMENT
1243050005OtherORDURABLE MEDICAL EQUIPMENT
1243050001OtherORDURABLE MEDICAL EQUIPMENT
1243050007OtherORDURABLE MEDICAL EQUIPMENT

National Provider Directory

National Provider Directory
Tax ID family
Eye Health Northwest Optical LLC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221609600000",
    "number": "1194940726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22009",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972692009",
            "telephone_number": "503-344-5102",
            "fax_number": "503-344-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11086 SE OAK ST",
            "address_2": "ADMINISTRATION",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972226692",
            "telephone_number": "503-344-5102",
            "fax_number": "503-344-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYEHEALTH NORTHWEST OPTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2008-09-17",
        "status": "A",
        "authorized_official_last_name": "BENTLEY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "WELLS",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "503-557-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DURABLE MEDICAL EQUIPMENT",
            "identifier": "1243050004",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DURABLE MEDICAL EQUIPMENT",
            "identifier": "1243050002",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DURABLE MEDICAL EQUIPMENT",
            "identifier": "1243050003",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DURABLE MEDICAL EQUIPMENT",
            "identifier": "1243050006",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DURABLE MEDICAL EQUIPMENT",
            "identifier": "1243050005",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DURABLE MEDICAL EQUIPMENT",
            "identifier": "1243050001",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DURABLE MEDICAL EQUIPMENT",
            "identifier": "1243050007",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukie, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2008; 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.