NPIMap

Organization Active NPI

Child Eye Care Associates, LLC

  • Ophthalmology Physician
  • Tigard, OR
National Provider Identifier
1417016429
Registry record updated Jun 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
CHILD EYE CARE ASSOCIATES, LLC
Practice address
9735 SW Shady Lane
Suite 203
Tigard, OR 97223
Phone
(503) 635-4436
Fax
(503) 635-7356
NPI assigned
Dec 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2014

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

Authorized official

Name
Susan Murray
Title
Clinic Manager
Phone
(503) 635-4436

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

9735 SW Shady Lane
Suite 203
Tigard, OR 97223

Mailing address

9735 SW Shady Lane
Suite 203
Tigard, OR 97223
Phone (503) 635-4436

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080211000538 OR Part B Supplier - Clinic/Group Practice 6002999257 Receives reassigned benefits from 4 practitioners
Practice locations: Tigard, OR

National Provider Directory

National Provider Directory

Locations

4035 Mercantile Dr
Ste 201
Lake Oswego, OR 97035
Phone (503) 635-4436

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402963200000",
    "number": "1417016429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9735 SW SHADY LANE",
            "address_2": "SUITE 203",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "97223",
            "telephone_number": "503-635-4436",
            "fax_number": "503-635-7356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9735 SW SHADY LANE",
            "address_2": "SUITE 203",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "97223",
            "telephone_number": "503-635-4436",
            "fax_number": "503-635-7356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD EYE CARE ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2014-06-17",
        "status": "A",
        "authorized_official_last_name": "MURRAY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "503-635-4436"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2014; 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.