Active NPI
George Richard Nelson, OD
- Optometrist
- Portland, OR
National Provider Identifier
1205829421
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1189T
- Practice address
- 611 SW Broadway
Portland, OR 97205-3402 - Phone
- (503) 227-5949
- Fax
- (503) 227-3621
- NPI assigned
- Aug 23, 2005
- Last updated
- Jul 13, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1189T | OR | Primary |
Addresses
Primary practice location
611 SW Broadway
Portland, OR 97205-3402
Mailing address
611 SW Broadway
Portland, OR 97205-3402
Phone (503) 227-5949
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1189T | OR | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cornell Eyecare Group, Inc | Optometrist | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1205829421",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "611 SW BROADWAY",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972053402",
"telephone_number": "503-227-5949",
"fax_number": "503-227-3621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 SW BROADWAY",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972053402",
"telephone_number": "503-227-5949",
"fax_number": "503-227-3621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "GEORGE",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-23",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OR",
"license": "1189T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.