Eyecare Center of Salem, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1472ATI Issued in OR

Legal business name

EYECARE CENTER OF SALEM, LLC

Practice address

660 Capitol St NE
Salem, OR 97301

Phone

(503) 364-0512

Fax

(503) 588-7108

NPI assigned

Mar 21, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Daniel Bishop, ODNPI 1740279793

Title

Member

Phone

(503) 364-0512

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daniel Dayton Bishop, OD

  • Optometrist
  • Salem, OR
  • NPI 1740279793
  Medicare reassignment Care Compare group NPD Authorized official
• Noah McGoff, OD

  • Optometrist
  • Salem, OR
  • NPI 1518856129
  Medicare reassignment Care Compare group NPD
• Gregory G. Kautz, O.D.

  • Optometrist
  • Salem, OR
  • NPI 1114934247
  Medicare reassignment NPD
• Gregory Lemay, OD

  • Optometrist
  • Tualatin, OR
  • NPI 1912559238
  Medicare reassignment NPD

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567468800000",
    "number": "1972629293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 CAPITOL ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973012504",
            "telephone_number": "503-364-0512",
            "fax_number": "503-588-7108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 CAPITOL ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97301",
            "telephone_number": "503-364-0512",
            "fax_number": "503-588-7108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE CENTER OF SALEM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2019-09-03",
        "status": "A",
        "authorized_official_last_name": "BISHOP",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "503-364-0512",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1472ATI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA MEDICARE",
            "identifier": "0434300001",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "T67431",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11376-1",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "1472ATI",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "807522000",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca J Ewing
• Extensions NW
• Eye Care Physicians & Surgeons, Inc.
• Eye Care Physicians & Surgeons, Inc.
• Eye Focus Northwest LLC
• Eyeglass Factory
• James M. Eyre Jr., M.D., D.M.D.
• Zena Rae Faber
• Amy Fagin
• Susan Mary Fagin, MENTAL HEALTH COUNSE

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2019; 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.