Gwen Thilavanh

Primary specialty

OptometristTaxonomy code 152W00000X

License

ATI4304 Issued in OR

Practice address

9201 SE 91St Ave Ste 130
Happy Valley, OR 97086-3760

Phone

(503) 775-2424

Fax

(503) 775-6181

NPI assigned

Mar 31, 2016

Last updated

Aug 22, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

River City Eyecare LLCGroup PAC ID 5294874673, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• River City Eyecare, LLC

  • Eyewear Supplier
  • Clackamas, OR
  • NPI 1578899472
  Medicare reassignment Care Compare group NPD
• Spectacle LLC

  dba Spectacle

  • Optometrist
  • Portland, OR
  • NPI 1376951293
  Medicare reassignment NPD
• Spectacle LLC

  • Optometrist
  • Beaverton, OR
  • NPI 1639646912
  NPD

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

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787356800000",
    "number": "1902269525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9201 SE 91ST AVE STE 130",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970863760",
            "telephone_number": "503-775-2424",
            "fax_number": "503-775-6181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9201 SE 91ST AVE STE 130",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970863760",
            "telephone_number": "503-775-2424",
            "fax_number": "503-775-6181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THILAVANH",
        "first_name": "GWEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-31",
        "last_updated": "2026-08-22",
        "certification_date": "2026-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "ATI4304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terrace Corporation (Town Center Village Rehab)
• Luwan Tesafsilase
• Nik Thanasouk
• The Salvation Army
• Therapeutic Associates Inc (TAI - Happy Valley)
• Alan Craig Thom, D.O.
• Keara Thomas
• Larry Lyman Tibbles, M.D.
• Patrick Tierney
• Timber and Iron Physical Therapy LLC

• Optometrist in Happy Valley, OR
• Providers in Happy Valley, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.