Active NPI
Brad Fortune, OD PHD
- Optometrist
- Portland, OR
National Provider Identifier
1932271566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2824T
- Practice address
- 1040 NW 22ND Avenue
Devers Eye Institute
Portland, OR 97210 - Phone
- (503) 413-1198
- Fax
- (503) 413-5179
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2824T | OR | Primary |
| Optometrist | 152W00000X | 9833 | CA |
Addresses
Primary practice location
1040 NW 22ND Avenue
Devers Eye Institute
Portland, OR 97210
Mailing address
1225 NE Second Avenue
3Rd Floor Discoveries in Sight
Portland, OR 97232
Phone (503) 413-1198
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 228831 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2824T | OR | MD | Optometrist |
| 9833 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932271566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1225 NE SECOND AVENUE",
"address_2": "3RD FLOOR DISCOVERIES IN SIGHT",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97232",
"telephone_number": "503-413-1198",
"fax_number": "503-413-5179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1040 NW 22ND AVENUE",
"address_2": "DEVERS EYE INSTITUTE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97210",
"telephone_number": "503-413-1198",
"fax_number": "503-413-5179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTUNE",
"first_name": "BRAD",
"credential": "OD PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OR",
"license": "2824T",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "9833",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "228831",
"state": "OR"
}
],
"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 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.