NPIMap

Organization Active NPI

Elemental Eyecare, PC

  • Optometrist
  • Bend, OR
National Provider Identifier
1205078284
Registry record updated Aug 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2635 ATI Issued in OR
Legal business name
ELEMENTAL EYECARE, PC
Practice address
2736 NW Crossing Dr
Suite 120
Bend, OR 97701
Phone
(541) 323-3937
Fax
(541) 323-3938
NPI assigned
Apr 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2018

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

Authorized official

Name
Mrs. Gabrielle Warren Marshall, O.D.NPI 1326122680
Title
Owner
Phone
(541) 323-3937

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 2635 ATI OR Primary
Pediatric OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WP0200X 2635 ATI OR
Vision Therapy OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WV0400X 2635 ATI OR
Eyewear Supplier 332H00000X

Addresses

Primary practice location

2736 NW Crossing Dr
Suite 120
Bend, OR 97701

Mailing address

2736 NW Crossing Dr
Suite 120
Bend, OR 97701-7180
Phone (541) 323-3937

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1238976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534291200000",
    "number": "1205078284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2736 NW CROSSING DR",
            "address_2": "SUITE 120",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017180",
            "telephone_number": "541-323-3937",
            "fax_number": "541-323-3938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2736 NW CROSSING DR",
            "address_2": "SUITE 120",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97701",
            "telephone_number": "541-323-3937",
            "fax_number": "541-323-3938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEMENTAL EYECARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-06",
        "last_updated": "2018-08-15",
        "status": "A",
        "authorized_official_last_name": "MARSHALL",
        "authorized_official_first_name": "GABRIELLE",
        "authorized_official_middle_name": "WARREN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-323-3937",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2635 ATI",
            "primary": true
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "OR",
            "license": "2635 ATI",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": "OR",
            "license": "2635 ATI",
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2018; 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.