NPIMap

Organization Active NPI

M. Kwon. P.C., Inc.

  • Optometrist
  • Portland, OR
National Provider Identifier
1770727059
Registry record updated Apr 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2764AT Issued in OR
Legal business name
M. KWON. P.C., INC.
Practice address
1260 Lloyd Ctr
Portland, OR 97232-1301
Phone
(503) 331-3984
NPI assigned
Apr 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2009

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

Authorized official

Name
Dr. Marielle Kwon, O.D.NPI 1417996976
Title
President
Phone
(509) 994-6264

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 2764AT OR Primary

Addresses

Primary practice location

1260 Lloyd Ctr
Portland, OR 97232-1301

Mailing address

2512 NW 12TH Cir
Camas, WA 98607-8886
Phone (509) 994-6264

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100112000443 OR Part B Supplier - Clinic/Group Practice 4981745080 Receives reassigned benefits from 4 practitioners
Practice locations: Portland, OR

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1241049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241049600000",
    "number": "1770727059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2512 NW 12TH CIR",
            "city": "CAMAS",
            "state": "WA",
            "postal_code": "986078886",
            "telephone_number": "509-994-6264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 LLOYD CTR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321301",
            "telephone_number": "503-331-3984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M. KWON. P.C., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-30",
        "last_updated": "2009-04-30",
        "status": "A",
        "authorized_official_last_name": "KWON",
        "authorized_official_first_name": "MARIELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-994-6264",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2764AT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2009; 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.