Active NPI
Kimberly A Matkevich, OD
- Optometrist
- Portland, OR
National Provider Identifier
1265449185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3182ATI
- Practice address
- 1775 NE 39TH Ave
Portland, OR 97212-5322 - Phone
- (503) 288-6181
- NPI assigned
- Aug 2, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | 3182ATI | OR | Primary |
Addresses
Primary practice location
1775 NE 39TH Ave
Portland, OR 97212-5322
Mailing address
3534 NE Alameda St
Portland, OR 97212-1806
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3182ATI | OR | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265449185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3534 NE ALAMEDA ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972121806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1775 NE 39TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972125322",
"telephone_number": "503-288-6181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATKEVICH",
"first_name": "KIMBERLY",
"middle_name": "A",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OR",
"license": "3182ATI",
"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 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.