NPIMap

Organization Active NPI

Lake Oswego Vision Clinic LLC

Doing business as Lake Oswego Vision Clinic

  • Optometrist
  • Lake Oswego, OR
National Provider Identifier
1750506937
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1115355-6 Issued in OR
Legal business name
LAKE OSWEGO VISION CLINIC LLC
Doing business as
Lake Oswego Vision Clinic
Practice address
15480 Boones Ferry Rd
Lake Oswego, OR 97035-3429
Phone
(503) 635-1458
NPI assigned
Apr 14, 2007
Last updated
Jul 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Authorized official

Name
Todd Michael SheldonNPI 1417980541
Title
President
Phone
(541) 548-2488

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1115355-6 OR Primary

Addresses

Primary practice location

15480 Boones Ferry Rd
Lake Oswego, OR 97035-3429

Mailing address

15480 Boones Ferry Rd
Lake Oswego, OR 97035-3429
Phone (503) 635-1458

Other names 1

  • Lake Oswego Vision Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040617001615 OR Part B Supplier - Clinic/Group Practice 8628052362 Receives reassigned benefits from 7 practitioners
Practice locations: Lake Oswego, OR

National Provider Directory

National Provider Directory

Locations

15480 Boones Ferry Rd
Lake Oswego, OR 97035
Phone (503) 635-1458

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1176508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752105600000",
    "number": "1750506937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15480 BOONES FERRY RD",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970353429",
            "telephone_number": "503-635-1458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15480 BOONES FERRY RD",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970353429",
            "telephone_number": "503-635-1458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE OSWEGO VISION CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-14",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-10",
        "status": "A",
        "authorized_official_last_name": "SHELDON",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-548-2488"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1115355-6",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Oswego Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Oswego Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Oswego, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2025; 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.