Active NPI
Tony Gendvilas, O.D.
- Optometrist
- Tigard, OR
National Provider Identifier
1730100876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1689T
- Practice address
- 9499 SW Washington Square Rd
Tigard, OR 97223-4448 - Phone
- (503) 968-5249
- Fax
- (503) 968-9237
- NPI assigned
- Jul 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1689T | OR | Primary |
Addresses
Primary practice location
9499 SW Washington Square Rd
Tigard, OR 97223-4448
Mailing address
PO Box 629
West Linn, OR 97068-0629
Phone (503) 631-8331
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1689 | OR | MD | Clinical Psychologist |
| 1689T | OR | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pacific Eye Group, PC. | Optometrist | Past | Accepting new patients |
| Master Eye Associates, P.C. | Optometrist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Beaverton, OR
- NPI 1245671924
-
- Optometrist
- Salem, OR
- NPI 1912554502
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1730100876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 629",
"city": "WEST LINN",
"state": "OR",
"postal_code": "970680629",
"telephone_number": "503-631-8331",
"fax_number": "503-212-9775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9499 SW WASHINGTON SQUARE RD",
"city": "TIGARD",
"state": "OR",
"postal_code": "972234448",
"telephone_number": "503-968-5249",
"fax_number": "503-968-9237"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENDVILAS",
"first_name": "TONY",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-22",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OR",
"license": "1689T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.