Travis Pack Lafayette, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OR 2729T Issued in OR

Practice address

19500 SE Stark St
Portland, OR 97233-5757

Phone

(503) 669-3900

NPI assigned

Aug 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kenneth Travis Pack Lafayette Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871606293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13865 SE 119TH DR",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970157607",
            "telephone_number": "503-698-3662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19500 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972335757",
            "telephone_number": "503-669-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAFAYETTE",
        "first_name": "TRAVIS",
        "middle_name": "PACK",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "OR 2729T",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "WA OD00003720",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENNETH",
            "last_name": "LAFAYETTE",
            "middle_name": "TRAVIS PACK",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• J'Querian Ty'Rhe Ladson
• Robert Ladu
• Jacqueline Ladue, MA
• Suzanne Denise Lady, DC
• Marisa Lafata
• Ginny Lee Laferriere, NP
• Angela Rae Laffredi, BT
• Timothy J Lafolette, PMHNP
• Gavin Lafontaine
• Heather Lynn Lafontaine, CSWA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.