Polk Vision Clinics Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1547T Issued in OR

Legal business name

POLK VISION CLINICS INC.

Doing business as

Central Vision Clinic
Dallas Vision Clinic
Waldport Eyecare

Practice address

506 Main St
Dallas, OR 97338-1915

Phone

(503) 623-9233

Fax

(503) 623-9233

NPI assigned

Jan 22, 2008

Last updated

Sep 18, 2024By 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

Geoffrey Wade Knowles, ODNPI 1285986513

Title

Provider

Phone

(503) 623-9233

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 3

• Central Vision Clinic Doing business as
• Dallas Vision Clinic Doing business as
• Waldport Eyecare Doing business as

Medicare fee-for-service enrollment

Enrolled in OR2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 6

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.

• Geoffrey Wade Knowles, OD

  • Optometrist
  • Dallas, OR
  • NPI 1285986513
  Medicare reassignment Care Compare group Authorized official
• Garrett Wayne Knowles, O.D.

  • Optometrist
  • Monmouth, OR
  • NPI 1790073856
  Medicare reassignment Care Compare group
• Grant Knowles, OD

  • Optometrist
  • Monmouth, OR
  • NPI 1710362058
  Medicare reassignment Care Compare group
• Merle Nye Berry, OD

  • Optometrist
  • Albany, OR
  • NPI 1164491825
  NPD (past)
• Kevin Dean Blair, OD

  • Optometrist
  • Albany, OR
  • NPI 1023087525
  NPD (past)
• Rodney W Bourdage, O.D.

  • Optometrist
  • Waldport, OR
  • NPI 1366591026
  NPD (past)

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

{
    "created_epoch": "1200960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1760669733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 MAIN ST",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381915",
            "telephone_number": "503-623-9233",
            "fax_number": "503-623-9233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 MAIN ST",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381915",
            "telephone_number": "503-623-9233",
            "fax_number": "503-623-9233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK VISION CLINICS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-22",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "KNOWLES",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "503-623-9233",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1547T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024687",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500695313",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500641229",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500690159",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dallas Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dallas Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Waldport Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Polk County Mental Health
• Polk County Mental Health
• Polk County Mental Health
• Polk County Mental Health
• Polk County Mental Health
• Polk Youth Services, Inc.
• Jason Dean Pool, MSW
• Sara Joy Porter, LMT
• Lyndsay Marie Posey, L.AC.
• Praxis Health, PC (Dallas Family Care)

• Optometrist in Dallas, OR
• Providers in Dallas, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; 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.