Acuity Vision Center, LLC
Organization Active NPI Optometrist · Gresham, OR
NPI 1306988605 · NPPES record last updated Oct 31, 2023
Key facts
- NPI
- 1306988605
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- OR2825ATI (OR)
- Legal business name
- ACUITY VISION CENTER, LLC
- Practice address
- 1380 E Powell Blvd
Gresham, OR 97030-8004 - Phone
- (503) 760-2525
- Fax
- (503) 895-2020
- NPI assigned
- Feb 13, 2007
- Organization subpart
- No
Authorized official
- Name
- Joseph Jungho An, OD
- Title
- Principal
- Phone
- (503) 760-2525
Practitioners 2
-
Joseph Jungho An, O.D.
-
Steven Clark, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040517000230 | OR | Part B Supplier - Clinic/Group Practice | 2567452048 |
Receives reassigned benefits from 1 practitioner Practice locations: Portland, OR |
National Provider Directory
Locations
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 118456 | Other | OR | PIN GROUP |
Other names
- Gresham Station Vision INC
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.