NPIMap

Organization Active NPI

Broadway Vision World

  • Optometrist
  • Portland, OR
National Provider Identifier
1295915700
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1863T Issued in OR
Legal business name
BROADWAY VISION WORLD
Practice address
1962 SW Broadway
Portland, OR 97201-6710
Phone
(503) 223-6655
Fax
(503) 233-6657
NPI assigned
Nov 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

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

Authorized official

Name
Dr. Kamelia Massih, OD
Title
Ceo
Phone
(503) 223-6655

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1863T OR Primary

Addresses

Primary practice location

1962 SW Broadway
Portland, OR 97201-6710

Mailing address

PO Box 108
Beaverton, OR 97075-0108
Phone (503) 223-6655

Other identifiers 1

IdentifierTypeStateIssuer
013354MedicaidOR

National Provider Directory

National Provider Directory

Locations

11020 SW Beaverton Hillsdale Hwy
Beaverton, OR 97005
Phone (503) 223-6655

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1295915700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 108",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970750108",
            "telephone_number": "503-223-6655",
            "fax_number": "503-223-6657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1962 SW BROADWAY",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972016710",
            "telephone_number": "503-223-6655",
            "fax_number": "503-233-6657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY VISION WORLD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-13",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "MASSIH",
        "authorized_official_first_name": "KAMELIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "503-223-6655",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1863T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013354",
            "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 Nov 13, 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.

Verify at the official NPI Registry.