NPIMap

Organization Active NPI

Optometric Care of Oregon

Doing business as Mt Hood Vision Center

  • Optometrist
  • Gresham, OR
National Provider Identifier
1396400313
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
OPTOMETRIC CARE OF OREGON
Doing business as
Mt Hood Vision Center
Practice address
22640 SE Stark St
Gresham, OR 97030-2684
Phone
(503) 667-0441
NPI assigned
Nov 4, 2021
Last updated
Sep 12, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
OPTOMETRIC CARE OF OREGONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Authorized official

Name
Steve Jung, ODNPI 1073616983
Title
Owner
Phone
(541) 338-4844

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

22640 SE Stark St
Gresham, OR 97030-2684

Mailing address

3333 Quality Dr
Rancho Cordova, CA 95670-7985

Other names 1

  • Mt Hood Vision Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220706000625 OR Part B Supplier - Clinic/Group Practice 4284014465 Receives reassigned benefits from 26 practitioners
5 other NPIs on this enrollment
Practice locations: Salem, OR; Medford, OR; Eugene, OR; Corvallis, OR; Gresham, OR

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Optometric Care of Oregon

Locations

207 Coburg Rd
Ste 105
Eugene, OR 97401
Phone (541) 338-4844

22640 SE Stark St
Gresham, OR 97030
Phone (503) 667-0441

935 Royal Ave
Medford, OR 97504
Phone (541) 779-2211

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1635984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694476800000",
    "number": "1396400313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 QUALITY DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22640 SE STARK ST",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970302684",
            "telephone_number": "503-667-0441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTOMETRIC CARE OF OREGON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPTOMETRIC CARE OF OREGON",
        "enumeration_date": "2021-11-04",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A",
        "authorized_official_last_name": "JUNG",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-338-4844",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt Hood Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gresham, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; 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.