Individual provider Active NPI

Brad C Richardson, O.D.

  • Optometrist
  • Forest Grove, OR
National Provider Identifier
1922009836
Registry record updated Jan 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1942AT ACTIVE Issued in OR
Practice address
2804 19TH Ave
Forest Grove, OR 97116-2625
Phone
(503) 357-2020
NPI assigned
Aug 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1942AT ACTIVE OR Primary
Hearing Instrument Specialist 237700000X HAS-P-470158 OR

Addresses

Primary practice location

2804 19TH Ave
Forest Grove, OR 97116-2625

Mailing address

PO Box 38
Forest Grove, OR 97116-0038
Phone (503) 357-2020

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120126000456 OR Practitioner - Optometry 9133396435 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2804 19TH Ave
Forest Grove, OR 97116-2625
Phone (503) 357-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1942AT ACTIVEORMDOptometrist
1942ORMDNaturopath
HAS-P-470158ORMDHearing Instrument Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Forest Grove Medical PC Optometrist CurrentSince Dec 16, 2011 Accepting new patients

Locations

2804 19th Ave
Forest Grove, OR 97116
Phone (503) 357-2020

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326240000000",
    "number": "1922009836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 38",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971160038",
            "telephone_number": "503-357-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2804 19TH AVE",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971162625",
            "telephone_number": "503-357-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "BRAD",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2012-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1942AT ACTIVE",
            "primary": true
        },
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "OR",
            "license": "HAS-P-470158",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Grove, OR

Sources for this page

Verify at the official NPI Registry.