Bret A. Provost, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3132 Issued in OR

Practice address

9201 SE 91St Ave
Suite 210
Clackamas, OR 97086-3760

Phone

(503) 775-2424

Fax

(503) 775-6181

NPI assigned

Jul 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

River City Eyecare LLCGroup PAC ID 5294874673, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• River City Eyecare, LLC

  • Eyewear Supplier
  • Clackamas, OR
  • NPI 1578899472
  Medicare reassignment Care Compare group NPD
• Pacific University

  • Adult Mental Health Clinic/Center
  • Portland, OR
  • NPI 1912377193
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272931200000",
    "number": "1528093556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9201 SE 91ST AVE",
            "address_2": "SUITE 210",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970863760",
            "telephone_number": "503-775-2424",
            "fax_number": "503-775-6181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9201 SE 91ST AVE",
            "address_2": "SUITE 210",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970863760",
            "telephone_number": "503-775-2424",
            "fax_number": "503-775-6181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVOST",
        "first_name": "BRET",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2010-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Proctor
• Proventus Psychiatry
• Providence Health & Services - Oregon
• Providence Health & Services Oregon
• Providence Health & Services Oregon
• Psychological Solutions Inc.
• Hannah Elizabeth Pugh, PHARM.D.
• Kristin E Pulliam, RRT
• Samantha Lee Pyne, AUD
• Cindy Lee Quale, P A

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2010; 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.