La Grande Family Eye Care

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

3311AT Issued in OR

Legal business name

LA GRANDE FAMILY EYE CARE

Practice address

1502 N Pine St
La Grande, OR 97850

Phone

(541) 963-3788

Fax

(541) 963-3091

NPI assigned

Jul 17, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Samuel Heber Kimball, ODNPI 1144458860

Title

Optometrist

Phone

(541) 963-3788

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR2 enrollments

Enrollment records 2

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

Medicare medical equipment & supply locations

Locations

Practitioners 5

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

• Samuel Heber Kimball, OD

  • Optometrist
  • La Grande, OR
  • NPI 1144458860
  Medicare reassignment Care Compare group NPD Authorized official
• David Kristopher Glabe, O.D., M.S.

  • Optometrist
  • La Grande, OR
  • NPI 1326377151
  Medicare reassignment Care Compare group NPD
• Jamison Riley Soupir, OD

  • Optometrist
  • Forest Grove, OR
  • NPI 1952826513
  Medicare reassignment Care Compare group NPD
• Donald Leon Peterson, OD

  • Optometrist
  • Redmond, OR
  • NPI 1215939137
  NPD (past)
• Steven M Wells, OD

  • Optometrist
  • Yakima, WA
  • NPI 1679581821
  NPD (past)

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

{
    "created_epoch": "1247788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283990400000",
    "number": "1376773960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 N PINE ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "97850",
            "telephone_number": "541-963-3788",
            "fax_number": "541-963-3091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 N PINE ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "97850",
            "telephone_number": "541-963-3788",
            "fax_number": "541-963-3091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA GRANDE FAMILY EYE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-17",
        "last_updated": "2010-09-09",
        "status": "A",
        "authorized_official_last_name": "KIMBALL",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "HEBER",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "541-963-3788",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "OR",
            "license": "3311AT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500609247",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James R Kopp, M.D.
• Kylee L Koshinsky, RN
• Koza Family Dental Care PC
• Brian L. Kruse, DMD
• Curtis Kunselman
• La Grande SD
• La Grande SD
• La Grande SNF Operations, LLC
• Lisa L Ladendorff, LCSW
• Lagrande Assisted Living LLC

• Eyewear Supplier in La Grande, OR
• Providers in La Grande, OR by specialty
• Eyewear Supplier in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2010; 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.