NPIMap

Organization Active NPI

Gresham Vision Center, Inc

  • Optometrist
  • Gresham, OR
National Provider Identifier
1619022076
Registry record updated Mar 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
GRESHAM VISION CENTER, INC
Practice address
125 NW Miller Ave
Gresham, OR 97030-7225
Phone
(503) 665-3813
NPI assigned
Jan 24, 2007
Last updated
Mar 19, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
R104410As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2015

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

Authorized official

Name
Diane Gardner
Title
Office Manager
Phone
(503) 665-3813

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

125 NW Miller Ave
Gresham, OR 97030-7225

Mailing address

125 NW Miller Ave
Gresham, OR 97030-7225

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040813000274 OR Part B Supplier - Clinic/Group Practice 8820061401 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
Practice locations: Gresham, OR; Sandy, OR
O20100930051350 OR DME Supplier - Physician - OptometristDME Supplier - Optician 8820061401 Practice locations: Gresham, OR

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Gresham Vision Center Inc125 NW Miller Ave, Gresham, OR 97030-7225(503) 665-3813 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jun 1, 1999

National Provider Directory

National Provider Directory
Part of
Gresham Vision Center Inc

Locations

39400 Pioneer Blvd
Ste 3
Sandy, OR 97055
Phone (503) 668-4313

Practitioners & affiliated clinicians

Practitioners 8

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": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426723200000",
    "number": "1619022076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 NW MILLER AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 NW MILLER AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307225",
            "telephone_number": "503-665-3813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRESHAM VISION CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "R104410",
        "enumeration_date": "2007-01-24",
        "last_updated": "2015-03-19",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-665-3813"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.