NPIMap

Organization Active NPI

Northwest Eye Care LLC

  • Optometrist
  • Clackamas, OR
National Provider Identifier
1669856902
Registry record updated Jul 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1620ATI Issued in OR
Legal business name
NORTHWEST EYE CARE LLC
Practice address
15259 SE 82ND Dr
Suite 101
Clackamas, OR 97015-6609
Phone
(503) 657-0321
Fax
(503) 657-7066
NPI assigned
Jul 16, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2015

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

Authorized official

Name
Dr. Bruce Robert Wojciechowski, O.D.NPI 1437247533
Title
Manager
Phone
(503) 657-0321

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 1620ATI OR Primary
Vision Therapy OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WV0400X 1620ATI OR

Addresses

Primary practice location

15259 SE 82ND Dr
Suite 101
Clackamas, OR 97015-6609

Mailing address

15259 SE 82ND Dr
Suite 101
Clackamas, OR 97015-6609
Phone (503) 657-0321

Other identifiers 2

IdentifierTypeStateIssuer
0213843OtherWAWORKER'S COMPENSATOIN
282442MedicaidOR

Other names 1

  • Northwest Eye Care Professionals Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150929002760 WA Part B Supplier - Clinic/Group Practice 7416265194 Receives reassigned benefits from 3 practitioners
Practice locations: Vancouver, WA
O20151014002693 OR Part B Supplier - Clinic/Group Practice 7416265194 Receives reassigned benefits from 7 practitioners
Practice locations: Clackamas, OR; Portland, OR; Hillsboro, OR

National Provider Directory

National Provider Directory

Locations

15259 SE 82nd Dr
Clackamas, OR 97015

10970 SW Barnes Rd
Portland, OR 97225
Phone (503) 214-1396

10970 SW Barnes Rd
Ste 101
Portland, OR 97225
Phone (503) 214-1396

1401 SE 164th Ave
Ste 100
Vancouver, WA 98683
Phone (360) 546-2046

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1437004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437004800000",
    "number": "1669856902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15259 SE 82ND DR",
            "address_2": "SUITE 101",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156609",
            "telephone_number": "503-657-0321",
            "fax_number": "503-657-7066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15259 SE 82ND DR",
            "address_2": "SUITE 101",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156609",
            "telephone_number": "503-657-0321",
            "fax_number": "503-657-7066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST EYE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-16",
        "last_updated": "2015-07-16",
        "status": "A",
        "authorized_official_last_name": "WOJCIECHOWSKI",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "503-657-0321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1620ATI",
            "primary": true
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": "OR",
            "license": "1620ATI",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKER'S COMPENSATOIN",
            "identifier": "0213843",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "282442",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Eye Care Professionals",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clackamas, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2015; 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.