Northwest Neuro-Ophthalmology LLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

NORTHWEST NEURO-OPHTHALMOLOGY LLC

Practice address

1585 SW Marlow Ave
Ste 110
Portland, OR 97225-5176

Phone

(503) 291-1422

Fax

(503) 297-8129

NPI assigned

Sep 9, 2015

Organization subpart

No

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

Authorized official

Name

Robert Egan, M.D.

Title

Owner/Member

Phone

(503) 291-1422

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1441756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445990400000",
    "number": "1619345683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1585 SW MARLOW AVE",
            "address_2": "STE 110",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255176",
            "telephone_number": "503-291-1422",
            "fax_number": "503-297-8129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1585 SW MARLOW AVE",
            "address_2": "STE 110",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255176",
            "telephone_number": "503-291-1422",
            "fax_number": "503-297-8129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST NEURO-OPHTHALMOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-09",
        "last_updated": "2015-10-28",
        "status": "A",
        "authorized_official_last_name": "EGAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "503-291-1422",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500693068",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Neurology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Neurology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.