Individual provider Active NPI

Chad Wayne Lawson, O.D.

  • Optometrist
  • Portland, OR
National Provider Identifier
1992859854
Registry record updated Sep 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2784ATI Issued in OR
Practice address
12955 NW Cornell Rd
Portland, OR 97229-5863
Phone
(503) 643-5556
Fax
(503) 641-2515
NPI assigned
Jan 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2784ATI OR Primary

Addresses

Primary practice location

12955 NW Cornell Rd
Portland, OR 97229-5863

Mailing address

12955 NW Cornell Rd
Portland, OR 97229-5863
Phone (503) 643-5556

Other identifiers 1

IdentifierTypeStateIssuer
18428-3MedicaidOR

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
I20050112000340 OR Practitioner - Optometry 7911955539 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2784ATIORMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Cornell Eyecare Group, Inc Optometrist CurrentSince May 1, 2004 Accepting new patients
Dr. Paul M. Wehner & Associates, PC Optometrist PastSince Sep 4, 2018 Accepting new patients
Abc Optometric PC Optometrist PastSince Jul 1, 2007 Accepting new patients

Locations

611 SW Broadway
Portland, OR 97205
Phone (503) 227-5949

15320 NW Central Dr
Ste D8
Portland, OR 97229
Phone (503) 430-0386

12955 NW Cornell Rd
Portland, OR 97229
Phone (503) 641-6985

Organizations & group practices 3

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": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222128000000",
    "number": "1992859854",
    "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": {
        "last_name": "LAWSON",
        "first_name": "CHAD",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2008-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2784ATI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18428-3",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.