Individual provider Active NPI

Dina H Erickson, O.D.

  • Optometrist
  • Forest Grove, OR
National Provider Identifier
1457460255
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4000ATI Issued in OR
Practice address
Pacific University College of Optometry
2043 College Way
Forest Grove, OR 97116
Phone
(503) 352-3007
Fax
(503) 352-2929
NPI assigned
Aug 29, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4000ATI OR Primary
Optometrist 152W00000X 10327T CA

Addresses

Primary practice location

Pacific University College of Optometry
2043 College Way
Forest Grove, OR 97116

Mailing address

Pacific University College of Optometry
2043 College Way
Forest Grove, OR 97116
Phone (503) 352-3007

Other identifiers 1

IdentifierTypeStateIssuer
208312MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040930000176 OR Practitioner - Optometry 4688643273 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific UniversityGroup PAC ID 0345144705, 30 clinicians

Practice addresses (Care Compare)

2043 College Way
Forest Grove, OR 97116-1756
Phone (503) 352-2756

222 SE 8TH Ave
Hillsboro, OR 97123-4218

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10327TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific University Optometrist Current Accepting new patients
Pacific University Optometrist CurrentSince Jan 3, 2007 Accepting new patients
Pacific University CurrentSince Jan 3, 2007 Accepting new patients
Pacific University Optometrist Past Accepting new patients
Pacific University Optometrist Past Accepting new patients

Locations

2043 College Way
Forest Grove, OR 97116
Phone (503) 352-2020

222 SE 8th Ave
#212
Hillsboro, OR 97123
Phone 5033522400 ext. 8060

222 SE 8th Ave
Ste 114
Hillsboro, OR 97123
Phone (503) 352-7300

1411 SW Morrison St
Ste 310
Portland, OR 97205

3653 SE 34th Ave
Portland, OR 97202
Phone (503) 988-3506

511 SW 10th Ave
Ste 500
Portland, OR 97205
Phone (503) 224-2323

5329 NE Mlk Jr Blvd
Portland, OR 97211
Phone (503) 988-3821

Interoperability endpoints

  • Direct secure messaging: derickson315783@direct.ochin.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457460255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PACIFIC UNIVERSITY COLLEGE OF OPTOMETRY",
            "address_2": "2043 COLLEGE WAY",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "97116",
            "telephone_number": "503-352-3007",
            "fax_number": "503-352-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PACIFIC UNIVERSITY COLLEGE OF OPTOMETRY",
            "address_2": "2043 COLLEGE WAY",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "97116",
            "telephone_number": "503-352-3007",
            "fax_number": "503-352-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "DINA",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "4000ATI",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10327T",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208312",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Grove, OR

Sources for this page

Verify at the official NPI Registry.