Cornell Eyecare Group, Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

2784ATI Issued in OR

Legal business name

CORNELL EYECARE GROUP, INC

Practice address

12955 NW Cornell Rd
Portland, OR 97229-5863

Phone

(503) 643-5556

Fax

(503) 641-2515

NPI assigned

Jan 22, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Chad Wayne Lawson, O.D.NPI 1992859854

Title

President

Phone

(503) 643-5556

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Cornell Eyecare Group Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 5

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

• Chad Wayne Lawson, O.D.

  • Optometrist
  • Portland, OR
  • NPI 1992859854
  Medicare reassignment NPD Authorized official
• Jessica Vo, OD

  • Optometrist
  • Portland, OR
  • NPI 1295410215
  NPD
• George Richard Nelson, OD

  • Optometrist
  • Portland, OR
  • NPI 1205829421
  NPD (past)
• Raymond Roy Jr., O.D.

  • Optometrist
  • Portland, OR
  • NPI 1811041734
  NPD (past)
• Paul M Wehner, OD

  • Optometrist
  • Junction City, OR
  • NPI 1912034208
  NPD (past)

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222128000000",
    "number": "1982758868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12955 NW CORNELL RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972295863",
            "telephone_number": "503-643-5556",
            "fax_number": "503-641-2515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12955 NW CORNELL RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972295863",
            "telephone_number": "503-643-5556",
            "fax_number": "503-641-2515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELL EYECARE GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2008-09-23",
        "status": "A",
        "authorized_official_last_name": "LAWSON",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-643-5556",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2784ATI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18428-3",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cornell Eyecare Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jared Corn, M.D
• Brandon J Cornejo, MD, PH.D.
• Amanda Williams Cornelius, SLP
• Selena Marie Cornelius
• Richard A Corneliuz, CPFT
• Cornell Family Dental
• Cornell Family Medicine
• Alexandra Gately Cornell, M.D.
• Corner Health Medical Group Northwest, P.C.
• Cornerstone Care Option

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; 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.