Advantage Optical, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3267ATI Issued in OR

Legal business name

ADVANTAGE OPTICAL, INC.

Practice address

502 Main St
Oregon City, OR 97045-1811

Phone

(503) 650-1839

Fax

(503) 650-5357

NPI assigned

Oct 25, 2013

Last updated

May 22, 2014By 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

Dr. Monica Ladouceur, OD

Title

Optometrist/Owner

Phone

(503) 650-1839

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1382659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400716800000",
    "number": "1720416944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 MAIN ST",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970451811",
            "telephone_number": "503-650-1839",
            "fax_number": "503-650-5357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 MAIN ST",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970451811",
            "telephone_number": "503-650-1839",
            "fax_number": "503-650-5357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE OPTICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-25",
        "last_updated": "2014-05-22",
        "status": "A",
        "authorized_official_last_name": "LADOUCEUR",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "503-650-1839",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3267ATI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500671079",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2014; 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.