Gresham Optical, Inc

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

GRESHAM OPTICAL, INC

Practice address

2150 NE Division St
Suite 101
Gresham, OR 97030-5813

Phone

(503) 667-2424

Fax

(503) 492-3236

NPI assigned

Nov 13, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Greg E Brophy, O.D.NPI 1699733758

Title

Optometrist

Phone

(503) 667-2424

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Greg Brophy, OD

  • Optometrist
  • Gresham, OR
  • NPI 1699733758
  Medicare reassignment NPD Authorized official
• Catherine B Saul, OD

  • Optometrist
  • Gresham, OR
  • NPI 1457323495
  Medicare reassignment NPD
• Valentin Ardeleanu, O.D.

  • Optometrist
  • Vancouver, WA
  • NPI 1639182116

  OR

  Medicare reassignment NPD

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

{
    "created_epoch": "1226534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440633600000",
    "number": "1760636005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2150 NE DIVISION ST",
            "address_2": "SUITE 101",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970305813",
            "telephone_number": "503-667-2424",
            "fax_number": "503-492-3236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 NE DIVISION ST",
            "address_2": "SUITE 101",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970305813",
            "telephone_number": "503-667-2424",
            "fax_number": "503-492-3236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRESHAM OPTICAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-13",
        "last_updated": "2015-08-27",
        "status": "A",
        "authorized_official_last_name": "BROPHY",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "503-667-2424",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001060",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gresham Podiatry Center, LLC
• Gresham Professional Pharmacy
• Gresham Sportscare
• Gresham Station Surgery Center LLC
• Gresham Therapeutic Massage Center

• Eyewear Supplier in Gresham, OR
• Providers in Gresham, OR by specialty
• Eyewear Supplier in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2015; 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.