Sandra J. Miyamoto, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

AT4601 Issued in OR

Practice address

4859 Meadows Rd Ste 155
Lake Oswego, OR 97035-2628

Phone

(503) 342-6853

Fax

(503) 342-6185

NPI assigned

Feb 12, 2007

Last updated

Apr 20, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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 1

Specialty

Optometry

Education

Other, 2006

Medicare assignment

May accept Medicare assignment

Group practices

Polsinelli Optometry PCGroup PAC ID 4486838950, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Polsinelli Optometry PC

  dba Polsinelli Optometry

  • Optometrist
  • Lake Oswego, OR
  • NPI 1811294291
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681948800000",
    "number": "1760524268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4859 MEADOWS RD",
            "address_2": "STE 155",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352628",
            "telephone_number": "503-342-6853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4859 MEADOWS RD STE 155",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352628",
            "telephone_number": "503-342-6853",
            "fax_number": "503-342-6185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIYAMOTO",
        "first_name": "SANDRA",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "007047",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13422",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "AT4601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Jean Mistele, PT
• Mitch Elovitz, LPC, LLC (Mitchell Elovitz)
• Laura Elise Mitchell, PHARMD
• Quinn Mitchell
• Michelle Mitsui, LCSW
• Deborah Mize, RN
• Modern Chiropractic, LLC (Modern Chiropractic)
• Janice Carole Modesitt, L.M.T.
• Mary Moffit, PH.D.
• Erin R Molstad, PT

• Optometrist in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.