Individual provider Active NPI

Valentin Ardeleanu, O.D.

  • Optometrist
  • Vancouver, WA
National Provider Identifier
1639182116
Registry record updated Feb 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD00003135 Issued in WA
Practice address
12607 SE Mill Plain Blvd.
Vancouver, WA 98684-4098
Phone
(360) 896-4456
Fax
(360) 896-4457
NPI assigned
Aug 14, 2006
Last updated
Feb 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3068ATI OR
Optometrist 152W00000X OD00003135 WA Primary

Addresses

Primary practice location

12607 SE Mill Plain Blvd.
Vancouver, WA 98684-4098

Mailing address

12607 SE Mill Plain Blvd.
Vancouver, WA 98684-4098
Phone (360) 896-4456

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20090216000207 OR Practitioner - Optometry 1456443837 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3068ATIORMDOptometrist
OD00003135WAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Gresham Optical, Inc CurrentSince Feb 5, 2024 Accepting new patients

Locations

2150 NE Division St
Ste 101
Gresham, OR 97030
Phone (503) 667-2424

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707955200000",
    "number": "1639182116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12607 SE MILL PLAIN BLVD.",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986844098",
            "telephone_number": "360-896-4456",
            "fax_number": "360-896-4457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12607 SE MILL PLAIN BLVD.",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986844098",
            "telephone_number": "360-896-4456",
            "fax_number": "360-896-4457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARDELEANU",
        "first_name": "VALENTIN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3068ATI",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00003135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.