Portland Oculoplastics, PC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

MD21723 Issued in OR

Legal business name

PORTLAND OCULOPLASTICS, PC

Practice address

10305 SW Park Way Ste 203
Portland, OR 97225-5033

Phone

(503) 223-8333

Fax

(503) 595-8160

NPI assigned

Dec 22, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Scot A Sullivan, M.D.NPI 1164481230

Title

President

Phone

(503) 223-8333

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 2

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

• Scot A Sullivan, M.D.

  • Ophthalmology Physician
  • Portland, OR
  • NPI 1164481230
  Medicare reassignment NPD Authorized official
• Robert Neill Tower, MD

  • Ophthalmology Physician
  • Portland, OR
  • NPI 1063512101
  NPD (past)

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

{
    "created_epoch": "1198281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633478400000",
    "number": "1316121692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10305 SW PARK WAY STE 203",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255033",
            "telephone_number": "503-223-8333",
            "fax_number": "503-595-8160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10305 SW PARK WAY STE 203",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255033",
            "telephone_number": "503-223-8333",
            "fax_number": "503-595-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND OCULOPLASTICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-22",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "SCOT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-223-8333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "OR",
            "license": "MD21723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Portland Neurosurgery PC
• Portland New Family Fund
• Portland Nutrition Group LLC
• Portland Obstetrics & Gynecology Associates PC
• Portland Ocd and Anxiety Center LLC
• Portland of Cascadia LLC (Secora Rehabilitation of Cascadia)
• Portland of Olympus, LLC
• Portland Opportunities Industrialization Center, Inc.
• Portland Oral and Facial Surgery
• Portland Ortho Pain & Spine LLC

• Ophthalmology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Ophthalmology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; 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.