Gresham Vision Source PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2987AT Issued in OR

Legal business name

GRESHAM VISION SOURCE PC

Practice address

929 NE 181St Ave
Portland, OR 97230-6757

Phone

(503) 669-1992

Fax

(503) 618-8262

NPI assigned

Oct 23, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Tuan Tu Nguyen, ODNPI 1194737916

Title

Optometrist Owner

Phone

(503) 669-1992

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 4

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

• Tuan Tu Nguyen, OD

  • Optometrist
  • Portland, OR
  • NPI 1194737916
  Medicare reassignment NPD Authorized official
• Catherine B Saul, OD

  • Optometrist
  • Gresham, OR
  • NPI 1457323495
  NPD
• Patricia Lyn Hazell, O.D.

  • Optometrist
  • Lubbock, TX
  • NPI 1154453199
  NPD (past)
• John E Reeves, OD

  • Optometrist
  • Great Falls, MT
  • NPI 1801867544
  NPD (past)

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519948800000",
    "number": "1346323367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 NE 181ST AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972306757",
            "telephone_number": "503-669-1992",
            "fax_number": "503-618-8262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 NE 181ST AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972306757",
            "telephone_number": "503-669-1992",
            "fax_number": "503-618-8262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRESHAM VISION SOURCE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2018-03-02",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "TUAN",
        "authorized_official_middle_name": "TU",
        "authorized_official_title_or_position": "OPTOMETRIST OWNER",
        "authorized_official_telephone_number": "503-669-1992",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2987AT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "V07577",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PIN",
            "identifier": "117114",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jolene Jeanelle Gremel, MD
• Hillary Gremillion, LMT
• Jan Grendar, M.D.
• Holly Grennan
• Gresham Family Dental, LLC
• Melissa Anne Greteman
• Kerry Ellen Grether
• Joseph Peter Gretsch, PSYD, ABPP, LICENSED
• Gurleen K Grewal, MPT, PT
• Kent Michael Grewe, M.D.

• Optometrist in Portland, OR
• Providers in Portland, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2018; 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.