Keiji Jay Shiyomura, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

ATI4607 Issued in OR

Practice address

61535 S Highway 97 Ste 16
Bend, OR 97702-2156

Phone

(541) 389-4774

Fax

(541) 389-3971

NPI assigned

Jan 11, 2022

Last updated

Feb 15, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aeg Oregon Professional LLCGroup PAC ID 5092156364, 11 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aeg Oregon Professional LLC

  • Optometrist
  • Salem, OR
  • NPI 1679253397
  Medicare reassignment Care Compare group
• Central Oregon Eyecare, PC

  • Optometrist
  • Redmond, OR
  • NPI 1073715157
  Medicare reassignment NPD
• Central Oregon Eyecare, PC

  • Optometrist
  • Bend, OR
  • NPI 1912389511
  NPD
• Coffman Vision Clinic Inc

  • Optometrist
  • Bend, OR
  • NPI 1811064967
  NPD

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

{
    "created_epoch": "1641859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707955200000",
    "number": "1609527613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61535 S HIGHWAY 97 STE 16",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977022156",
            "telephone_number": "541-389-4774",
            "fax_number": "541-389-3971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61535 S HIGHWAY 97 STE 16",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977022156",
            "telephone_number": "541-389-4774",
            "fax_number": "541-389-3971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIYOMURA",
        "first_name": "KEIJI",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-01-11",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "ATI4607",
            "primary": true
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "OR",
            "license": "ATI4607",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Shipley, MA
• Janet M Shipps, LPN
• William Ward Shirk, OPTOMETRIST
• Leah Marita Shirley-Biddle, RN
• Kenneth Shirtcliff, D.M.D.
• Jena Shlegeris
• Jessica K Shoemaker
• Luke Shoemaker
• Steven Louis Shope, BS
• Shopko Stores Operating Co LLC (ShopKo Optical 093)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2024; 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.