Bend Family Vision Care LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

BEND FAMILY VISION CARE LLC

Doing business as

Bend Family Vision Care

Practice address

1470 SW Knoll Ave Ste 102
Bend, OR 97702-3154

Phone

(541) 797-0295

Fax

(541) 797-7685

NPI assigned

Oct 17, 2023

Last updated

Apr 16, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Diana Lee Cooper

Title

Billing Manager

Phone

(541) 740-8021

Specialties & licenses 2

Addresses

Other names 1

• Bend Family Vision Care Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 4

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.

• Michael D Klautzsch, OD

  • Optometrist
  • Bend, OR
  • NPI 1164601167
  Medicare reassignment NPD
• Shannon Marie Buckmaster, OD

  • Optometrist
  • St George, UT
  • NPI 1346234275

  OR

  Medicare reassignment NPD
• Rebecca Macdow, OD

  • Optometrist
  • Corvallis, OR
  • NPI 1083391890
  NPD (past)
• Elena Talea, OD

  • Optometrist
  • Hillsboro, OR
  • NPI 1053047944
  NPD (past)

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

{
    "created_epoch": "1697500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713225600000",
    "number": "1619759453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1470 SW KNOLL AVE STE 102",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023154",
            "telephone_number": "541-797-0295",
            "fax_number": "541-797-7685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1470 SW KNOLL AVE STE 102",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023154",
            "telephone_number": "541-797-0295",
            "fax_number": "541-797-7685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEND FAMILY VISION CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-17",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "541-740-8021"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bend Family Vision Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bend Family Vision Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 Apr 16, 2024; 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.