Gresham Vision Center, Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

T67476 Issued in OR

Legal business name

GRESHAM VISION CENTER, INC

Doing business as

sandy vision center

Practice address

39400 Pioneer Blvd Ste 3
Sandy, OR 97055-8000

Phone

(503) 668-4313

Fax

(503) 668-5963

NPI assigned

Jul 4, 2006

Last updated

Mar 19, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

GRESHAM VISION CENTERAs reported in NPPES

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

Authorized official

Name

Diane Gardner

Title

Office Manager

Phone

(503) 665-3813

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• sandy vision center Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Gresham Vision Center, Inc

  • Optometrist
  • Gresham, OR
  • NPI 1619022076

  O20040813000274

  Same enrollment

Part of

Gresham Vision Center Inc

Locations

Practitioners 6

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.

• Nancy Brock, O.D.

  • Optometrist
  • Happy Valley, OR
  • NPI 1447306360
  NPD
• Patrick Kwong, OD

  • Optometrist
  • Portland, OR
  • NPI 1427041961
  NPD
• Prescott Briggs McArthur, OD

  • Optometrist
  • Gresham, OR
  • NPI 1013771997
  NPD
• Dane Agost

  • Optometrist
  • Gresham, OR
  • NPI 1376461657
  NPD (past)
• Tina Jeo, O.D.

  • Optometrist
  • Sandy, OR
  • NPI 1184841553
  NPD (past)
• Catherine B Saul, OD

  • Optometrist
  • Gresham, OR
  • NPI 1457323495
  NPD (past)

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426723200000",
    "number": "1447280490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39400 PIONEER BLVD STE 3",
            "city": "SANDY",
            "state": "OR",
            "postal_code": "970558000",
            "telephone_number": "503-668-4313",
            "fax_number": "503-668-5963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39400 PIONEER BLVD STE 3",
            "city": "SANDY",
            "state": "OR",
            "postal_code": "970558000",
            "telephone_number": "503-668-4313",
            "fax_number": "503-668-5963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRESHAM VISION CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRESHAM VISION CENTER",
        "enumeration_date": "2006-07-04",
        "last_updated": "2015-03-19",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-665-3813"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1627ATI",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2474ATI",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "T67476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022759",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "sandy vision center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Agaiby George, R.PH
• Andrea Gillette, RN
• Hannah Glaser
• Brianna R. Gover, RN
• Jason M Gray
• William Anthony Gromko, M.D.
• Victoria Elizabeth Guinn, DPT, PT
• Amy R Haase, RN
• Crystal Anne Hall, LPC, LMHC
• Ernest E Hamilton, D.C.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; 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.