Hillsboro Eye Clinic, PC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

HILLSBORO EYE CLINIC, PC

Practice address

18650 NW Cornell Rd
Suite 112
Hillsboro, OR 97124-9208

Phone

(503) 645-8808

Fax

(503) 693-0441

NPI assigned

Oct 3, 2006

Organization subpart

Yes

Parent organization

HILLSBORO EYE CLINIC, PCAs reported in NPPES

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

Authorized official

Name

Dr. Timothy L Gard, MD

Title

President

Phone

(503) 640-3708

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tanasbourne Optical Other name

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Hillsboro Eye Clinic PC

  • Eyewear Supplier
  • Hillsboro, OR
  • NPI 1821185588

  2961499348

  Same PAC ID
• Hillsboro Eye Clinic, PC

  • Ophthalmology Physician
  • Hillsboro, OR
  • NPI 1275578775

  2961499348

  Same PAC ID
• Hillsboro Eye Clinic, PC

  • Eyewear Supplier
  • Hillsboro, OR
  • NPI 1508500265

  2961499348

  Same PAC ID

Tax ID family

Hillsboro Opticians3 organizations share this tax ID, including this one

Part of

Hillsboro Opticians

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Hillsboro Eye Clinic PC

  • Eyewear Supplier
  • Hillsboro, OR
  • NPI 1821185588
  NPD tax ID
• Hillsboro Eye Clinic, PC

  • Eyewear Supplier
  • Hillsboro, OR
  • NPI 1508500265
  NPD tax ID

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.

• Hillsboro Eye Clinic, PC

  • Ophthalmology Physician
  • Hillsboro, OR
  • NPI 1275578775
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655337600000",
    "number": "1275628869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 E MAIN ST",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971239208",
            "telephone_number": "503-640-3708",
            "fax_number": "503-693-0441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18650 NW CORNELL RD",
            "address_2": "SUITE 112",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971249208",
            "telephone_number": "503-645-8808",
            "fax_number": "503-693-0441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HILLSBORO EYE CLINIC, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HILLSBORO EYE CLINIC, PC",
        "enumeration_date": "2006-10-03",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A",
        "authorized_official_last_name": "GARD",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-640-3708",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "278569",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tanasbourne Optical",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Eyewear Supplier in Hillsboro, OR
• Providers in Hillsboro, OR by specialty
• Eyewear Supplier in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.