Dane Agost
Individual provider Active NPI Optometrist · Gresham, OR
NPI 1376461657 · NPPES record last updated Jul 6, 2026
Key facts
- NPI
- 1376461657
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4829 (OR)
- Practice address
- 125 NW Miller Ave
Gresham, OR 97030-7225 - Phone
- (503) 665-3813
- NPI assigned
- Jul 6, 2026
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- University of Houston - College of Optometry, 2026
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
12976 SE 126TH Ave
Happy Valley, OR 97086-4363
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gresham Vision Center, Inc | Optometrist | Past |
Accepting new patients |
| Gresham Vision Center, Inc | Optometrist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4829 | OR | Yes |
Addresses
Primary practice location
125 NW Miller Ave
Gresham, OR 97030-7225
Mailing address
12976 SE 126TH Ave
Happy Valley, OR 97086-4363
Phone (503) 780-7071
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 6, 2026. 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.