Joseph Jungho An, O.D.
Individual provider Active NPI Optometrist · Gresham, OR
NPI 1235271511 · NPPES record last updated Oct 31, 2023
Key facts
- NPI
- 1235271511
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OR2825ATI (OR)
- Practice address
- 1380 E Powell Blvd
Gresham, OR 97030-8004 - Phone
- (503) 760-2525
- Fax
- (503) 895-2020
- NPI assigned
- Feb 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 2001
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
2520 SE 145TH Ave
Suite B
Portland, OR 97236-2671
Phone (503) 760-2525
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040518000111 | OR | Practitioner - Optometry | 2567452063 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OR2825ATI | OR | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Acuity Vision Center, LLC | Optometrist | Current |
Accepting new patients |
Locations
1380 E Powell Blvd
Gresham, OR 97030
Phone (503) 760-2525
2520 SE 145th Ave
Ste B
Portland, OR 97236
Phone (503) 760-2525
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OR2825ATI | OR | Yes |
Addresses
Primary practice location
1380 E Powell Blvd
Gresham, OR 97030-8004
Mailing address
1380 E Powell Blvd
Gresham, OR 97030-8004
Phone (503) 760-2525
Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.