NPIMap

Organization Active NPI

Tigard Vision Center, Inc.

  • Optometrist
  • Tigard, OR
National Provider Identifier
1821083635
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
TIGARD VISION CENTER, INC.
Practice address
9169 SW Burnham St
Tigard, OR 97223-6105
Phone
(503) 639-5115
Fax
(503) 624-0542
NPI assigned
Sep 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

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

Authorized official

Name
Dr. Todd Sheldon, OD
Title
Owner
Phone
(503) 639-5115

Specialties & licenses 1

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

Addresses

Primary practice location

9169 SW Burnham St
Tigard, OR 97223-6105

Mailing address

9169 SW Burnham St
Tigard, OR 97223-6105
Phone (503) 639-5115

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040506000324 OR Part B Supplier - Clinic/Group Practice 1355339300 Receives reassigned benefits from 10 practitioners
Practice locations: Tigard, OR

National Provider Directory

National Provider Directory

Locations

9196 SW Burnham St
Portland, OR 97223

Practitioners & affiliated clinicians

Practitioners 10

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": "1127088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713225600000",
    "number": "1821083635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9169 SW BURNHAM ST",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236105",
            "telephone_number": "503-639-5115",
            "fax_number": "503-624-0542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9169 SW BURNHAM ST",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236105",
            "telephone_number": "503-639-5115",
            "fax_number": "503-624-0542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIGARD VISION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-19",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A",
        "authorized_official_last_name": "SHELDON",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-639-5115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2024; 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.