Individual provider Active NPI

Nicole Jane Laske, OD

  • Optometrist
  • Hillsboro, OR
National Provider Identifier
1740390558
Registry record updated Feb 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2783 ATI Issued in OR
Practice address
Kaiser Permanente Sunset Medical Office
19400 NW Evergreen Pwy
Hillsboro, OR 97124-7031
Phone
(503) 690-5005
NPI assigned
Aug 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2783 ATI OR Primary

Addresses

Primary practice location

Kaiser Permanente Sunset Medical Office
19400 NW Evergreen Pwy
Hillsboro, OR 97124-7031

Mailing address

Kaiser Permanente Sunset Medical Office
19400 NW Evergreen Pwy
Hillsboro, OR 97124-7031
Phone (503) 690-5005

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE) Northwest Permanente PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080411000488 OR Practitioner - Optometry 4183701345 Reassigns benefits to 1 organization
I20210916002754 WA Practitioner - Optometry 4183701345 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

10180 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2783 ATIORMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jun 26, 2013 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jun 26, 2013 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jun 2, 2021 Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643932800000",
    "number": "1740390558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "KAISER PERMANENTE SUNSET MEDICAL OFFICE",
            "address_2": "19400 NW EVERGREEN PWY",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971247031",
            "telephone_number": "503-690-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "KAISER PERMANENTE SUNSET MEDICAL OFFICE",
            "address_2": "19400 NW EVERGREEN PWY",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971247031",
            "telephone_number": "503-690-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASKE",
        "first_name": "NICOLE",
        "middle_name": "JANE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2783 ATI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Northwest Permanente PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10600 NE Evergreen Pkwy",
            "city": "Hillsboro",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971247031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hillsboro, OR

Sources for this page

Verify at the official NPI Registry.