Active NPI
Shane McDonald, O.D.
- Optometrist
- Portland, OR
National Provider Identifier
1982096525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3606ATI
- Practice address
- 3303 SW Bond Ave FL 11
Portland, OR 97239-4501 - Phone
- (503) 494-3000
- NPI assigned
- Feb 18, 2015
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3606ATI | OR | Primary |
Addresses
Primary practice location
3303 SW Bond Ave FL 11
Portland, OR 97239-4501
Mailing address
6985 Rosen Lake Rd.
Box 13
Jaffray, BRITISH COLUMBIA V0B1T0
CA
Phone (503) 707-0409
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3606ATI | OR | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Professional Services | Past | Accepting new patients |
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.
-
- Pediatrics Physician
- Medford, OR
- NPI 1225282122
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433980800000",
"number": "1982096525",
"addresses": [
{
"country_code": "CA",
"country_name": "Canada",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "6985 ROSEN LAKE RD.",
"address_2": "BOX 13",
"city": "JAFFRAY",
"state": "BRITISH COLUMBIA",
"postal_code": "V0B1T0",
"telephone_number": "503-707-0409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3303 SW BOND AVE FL 11",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972394501",
"telephone_number": "503-494-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONALD",
"first_name": "SHANE",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-02-18",
"last_updated": "2015-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OR",
"license": "3606ATI",
"primary": true
}
],
"identifiers": [],
"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 Jun 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.