Brett Agost, O.D.
Individual provider Active NPI Optometrist · Gresham, OR
NPI 1326030883 · NPPES record last updated Jul 28, 2010
Key facts
- NPI
- 1326030883
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2497ATI (OR)
- Practice address
- 125 NW Miller
Gresham, OR 97030 - Phone
- (503) 665-3813
- Fax
- (503) 492-2313
- NPI assigned
- Aug 19, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gresham Vision Center Inc
Practice addresses (Care Compare)
125 NW Miller Ave
Gresham, OR 97030-7225
Phone (503) 665-3813
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 15 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110126000279 | OR | Practitioner - Optometry | 1557368875 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2497ATI | OR | MD | Optometrist |
| 2497T | OR | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2497T | OR | |
| Optometrist | 152W00000X | 2497ATI | OR | Yes |
Addresses
Primary practice location
125 NW Miller
Gresham, OR 97030
Mailing address
125 NW Miller
Gresham, OR 97030
Phone (503) 665-3813
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 120167 | Medicaid | OR |
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 Jul 28, 2010. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.