NPIMap

Organization Active NPI

Bernard P Conway OD PC

Doing business as Specs 20/20

  • Optometrist
  • Portland, OR
National Provider Identifier
1609268051
Registry record updated Jun 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BERNARD P CONWAY OD PC
Doing business as
Specs 20/20
Practice address
11805 NW Cedar Falls Dr
Suite 105
Portland, OR 97229-2774
Phone
(503) 747-0265
NPI assigned
Feb 23, 2015
Last updated
Jun 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2015

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

Authorized official

Name
Bernard P Conway, ODNPI 1285642421
Title
President
Phone
(503) 330-6478

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

11805 NW Cedar Falls Dr
Suite 105
Portland, OR 97229-2774

Mailing address

700 NW 118TH Ave
No. 103
Portland, OR 97229-5925
Phone (503) 747-0265

Other names 1

  • Specs 20/20 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150609000858 OR Part B Supplier - Clinic/Group Practice 2466773999 Receives reassigned benefits from 3 practitioners
Practice locations: Portland, OR

National Provider Directory

National Provider Directory

Locations

11805 NW Cedar Falls Dr
Ste 105
Portland, OR 97229
Phone (503) 747-0265

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1424649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433808000000",
    "number": "1609268051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 NW 118TH AVE",
            "address_2": "NO. 103",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972295925",
            "telephone_number": "503-747-0265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11805 NW CEDAR FALLS DR",
            "address_2": "SUITE 105",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972292774",
            "telephone_number": "503-747-0265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERNARD P CONWAY OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-23",
        "last_updated": "2015-06-09",
        "status": "A",
        "authorized_official_last_name": "CONWAY",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-330-6478",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Specs 20/20",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.