Lorne Yudcovitch, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2588AT Issued in OR

Practice address

2043 College Way
Forest Grove, OR 97116-1756

Phone

(503) 352-2781

NPI assigned

Oct 31, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 5

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

Specialty

Optometry

Education

Pacific University - College of Optometry, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pacific UniversityGroup PAC ID 0345144705, 30 clinicians

Innervision Optometric Inc.Group PAC ID 2567453160, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://eyetoeyewilsonville.ef.prod.fhir.ema-api.com/fhir/r4/
• Direct secure messaging: lyudcovitch315820@direct.ochin.org

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

• Innervision Optometric Inc.

  • Optometrist
  • Wilsonville, OR
  • NPI 1962534578
  Medicare reassignment Care Compare group NPD
• Pacific University

  • Optometrist
  • Hillsboro, OR
  • NPI 1306954011
  Medicare reassignment Care Compare group NPD
• Pacific University

  • Adult Mental Health Clinic/Center
  • Portland, OR
  • NPI 1912377193
  NPD
• Pacific University

  • Optometrist
  • Cornelius, OR
  • NPI 1124225842
  NPD (past)
• Pacific University

  • Optometrist
  • Beaverton, OR
  • NPI 1124319009
  NPD (past)
• Pacific University

  • Optometrist
  • Forest Grove, OR
  • NPI 1689782393
  NPD (past)
• Pacific University

  • Adult Mental Health Clinic/Center
  • Hillsboro, OR
  • NPI 1700256989
  NPD (past)

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586736000000",
    "number": "1487645586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22165 NE FRYER HILL RD",
            "city": "DUNDEE",
            "state": "OR",
            "postal_code": "971159179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2043 COLLEGE WAY",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971161756",
            "telephone_number": "503-352-2781"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8269 SW Wilsonville Rd Ste G",
            "address_purpose": "LOCATION",
            "city": "Wilsonville",
            "state": "OR",
            "postal_code": "970707719",
            "country_code": "US",
            "telephone_number": "503-685-9015",
            "fax_number": "503-682-8696",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YUDCOVITCH",
        "first_name": "LORNE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2020-04-13",
        "certification_date": "2020-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "OR",
            "license": "2588AT",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "OR",
            "license": "2588AT",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2588AT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168366",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC HMO/FC 65",
            "identifier": "300200803",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OPTOMETRY LICENSE #",
            "identifier": "2588AT",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "5255690001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "831474004",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Nicole Wustenberg, RDH
• Nicole Wyman
• Ying Yao, LMT
• Teresa W. Yip, NP (NURSE PRACTITION
• Judith Ann Younkins, RPH
• Philip M Zapf, DC
• Frank Zheng
• Jennifer Leanne Ziegler
• Timothy Joseph Zoebelein, LCSW

• Optometrist in Forest Grove, OR
• Providers in Forest Grove, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.