NPIMap

Organization Active NPI

Eye Care Group of Southern Oregon, LLC

Doing business as Eye Care Group

  • Optometrist
  • Grants Pass, OR
National Provider Identifier
1306988787
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EYE CARE GROUP OF SOUTHERN OREGON, LLC
Doing business as
Eye Care Group
Practice address
1022 NW 6TH St
Grants Pass, OR 97526-1114
Phone
(541) 476-4545
Fax
(541) 479-5985
NPI assigned
Feb 13, 2007
Last updated
Jan 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2024

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

Authorized official

Name
Dr. Jeffrey S Pelson, ODNPI 1578567244
Title
Owner
Phone
(541) 476-4545

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

1022 NW 6TH St
Grants Pass, OR 97526-1114

Mailing address

1022 NW 6TH St
Grants Pass, OR 97526-1114
Phone (541) 476-4545

Other identifiers 1

IdentifierTypeStateIssuer
005729MedicaidOR

Other names 1

  • Eye Care Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060209000139 OR Part B Supplier - Clinic/Group Practice 4082629290 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
Practice locations: Cave Junction, OR; Grants Pass, OR
O20100930099134 OR DME Supplier - Physician - Optometrist 4082629290 Practice locations: Grants Pass, OR

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D1018801Eye Care Group Optical Physicians1022 NW 6TH Street, Grants Pass, OR 97526Certificate of waiverOct 30, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Eye Care Group of Southern Oregon -1022 NW 6TH St, Grants Pass, OR 97526-1114(541) 476-4545 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 13, 2006

National Provider Directory

National Provider Directory
Tax ID family
Eye Care Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Interoperability endpoints

  • Direct secure messaging: maisha.langella.eyecaregroupso@jhie.net

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1306988787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1022 NW 6TH ST",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261114",
            "telephone_number": "541-476-4545",
            "fax_number": "541-479-5985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1022 NW 6TH ST",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261114",
            "telephone_number": "541-476-4545",
            "fax_number": "541-479-5985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CARE GROUP OF SOUTHERN OREGON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "PELSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-476-4545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005729",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Care Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grants Pass, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.