Eye Health Eastside Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

07-1553 Issued in OR

Legal business name

EYE HEALTH EASTSIDE SURGERY CENTER

Practice address

12050 SE Stevens Rd Ste 400
Portland, OR 97086-7667

Phone

(971) 206-6100

Fax

(971) 206-6103

NPI assigned

Nov 7, 2005

Last updated

Apr 5, 2022By 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

Brett Williams

Title

Ceo

Phone

(503) 344-5101

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Listed as

Eyehealth Eastside Surgery Center LLCCCN 38C0001059

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Eye Health Eastside Surgery2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Eye Health Eastside Surgery Center, LLC

  • Durable Medical Equipment & Medical Supplies
  • Portland, OR
  • NPI 1427030881
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shane K. Kim, MD

  • Ophthalmology Physician
  • Portland, OR
  • NPI 1801974027
  NPD (past)

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1750362869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220059",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972690059",
            "telephone_number": "503-558-7372",
            "fax_number": "503-344-5140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12050 SE STEVENS RD STE 400",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "970867667",
            "telephone_number": "971-206-6100",
            "fax_number": "971-206-6103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE HEALTH EASTSIDE SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-07",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "503-344-5101"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OR",
            "license": "07-1553",
            "primary": true
        },
        {
            "code": "261QS0132X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ophthalmologic Surgery",
            "state": "OR",
            "license": "07-1553",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275034",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Expedition Acupuncture
• Express Care Or PC (Providence Express Care)
• Alexis Extine
• Sydney Susan Ey, PH.D.
• Eye Group Associates PC
• Eye Health Eastside Surgery Center, LLC
• Eye Health Northwest Optical, LLC
• Eye Health Northwest Optical, LLC
• Eye Health Northwest Optical, LLC
• Eye Health Northwest Optical, LLC

• Ambulatory Surgical Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• Ambulatory Surgical Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.