Active NPI
Eye Health Northwest P.C.
- Ophthalmology Physician
- Portland, OR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- Legal business name
- EYE HEALTH NORTHWEST P.C.
- Practice address
- 3246 N Lombard St
Portland, OR 97217-1206 - Phone
- (503) 285-1671
- Fax
- (503) 285-7859
- NPI assigned
- Sep 29, 2009
- Last updated
- Feb 20, 2021
- Organization subpart
- Yes
- Parent organization
- EYE HEALTH NORTHWEST P.C.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Shane K Kim, M.D.
- Title
- President
- Phone
- (503) 255-2291
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | Primary |
Addresses
Primary practice location
3246 N Lombard St
Portland, OR 97217-1206
Mailing address
PO Box 22009
Milwaukie, OR 97269-2009
Phone (503) 558-7372
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 085006 | Medicaid | OR |
National Provider Directory
National Provider Directory- Part of
- Plaza Optical
Locations
3246 N Lombard St
Portland, OR 97217
Phone (503) 285-1671
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Ophthalmology Physician
- Portland, OR
- NPI 1992397426
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.
-
- Ophthalmology Physician
- Portland, OR
- NPI 1801974027
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254182400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1613779200000",
"number": "1235463894",
"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": "503-558-7372",
"fax_number": "503-344-5140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3246 N LOMBARD ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972171206",
"telephone_number": "503-285-1671",
"fax_number": "503-285-7859"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EYE HEALTH NORTHWEST P.C.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "EYE HEALTH NORTHWEST P.C.",
"enumeration_date": "2009-09-29",
"last_updated": "2021-02-20",
"certification_date": "2021-02-20",
"status": "A",
"authorized_official_last_name": "KIM",
"authorized_official_first_name": "SHANE",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "503-255-2291",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "085006",
"state": "OR"
}
],
"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 Feb 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.