Active NPI
John Alexander Smith, O.D.
- Low Vision Rehabilitation Optometrist
- Forest Grove, OR
National Provider Identifier
1609808237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Low Vision Rehabilitation Optometrist
- License
- 1509ATI
- Practice address
- 2043 College Way
Forest Grove, OR 97116-1756 - Phone
- (503) 352-2881
- Fax
- (503) 352-2929
- NPI assigned
- Jul 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Low Vision Rehabilitation Optometrist | 152WL0500X | 1509ATI | OR | Primary |
Addresses
Primary practice location
2043 College Way
Forest Grove, OR 97116-1756
Mailing address
2043 College Way
Forest Grove, OR 97116-1756
Phone (503) 352-2881
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 222190 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609808237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2043 COLLEGE WAY",
"city": "FOREST GROVE",
"state": "OR",
"postal_code": "971161756",
"telephone_number": "503-352-2881",
"fax_number": "503-352-2929"
},
{
"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": "503-352-2881",
"fax_number": "503-352-2929"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JOHN",
"middle_name": "ALEXANDER",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152WL0500X",
"taxonomy_group": "",
"desc": "Optometrist, Low Vision Rehabilitation",
"state": "OR",
"license": "1509ATI",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "222190",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Forest Grove, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.