Tad Willis Buckingham, O.D.
Individual provider Active NPI Optometrist · Gaston, OR
NPI 1992876056 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992876056
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4022ATI (OR)
- Practice address
- 7615 SW Speaks Dr
Gaston, OR 97119-9117 - Phone
- (503) 459-9247
- Fax
- (503) 357-5493
- NPI assigned
- Nov 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 34
Hospital & facility affiliations 35
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southeast Alaska Regional Health Consortium
Practice addresses (Care Compare)
1204 Seward Ave
Searhc 1204 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611
1206 Seward Ave
Searhc 1206 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611
1209 Seward Ave
Searhc 1209 Behavioral
Sitka, AK 99835-7359
Phone (907) 966-8611
222 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411
227 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411
Hospital & facility affiliations
- Southeast Alaska Regional Health Consortium
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070404000449 | OR | Practitioner - Optometry | 7719081421 | Reassigns benefits to 1 organization |
| I20210218002646 | TX | Practitioner - Optometry | 7719081421 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4022 | OR | MD | Naturopath |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Pacific University | Optometrist | Current | Accepting new patients |
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Pacific University | Current |
Accepting new patients | |
| Southeast Alaska Regional Health Consortium | Current |
Accepting new patients | |
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Southeast Alaska Regional Health Consortium | Current |
Accepting new patients | |
| Pacific University | Optometrist | Current |
Accepting new patients |
| Southeast Alaska Regional Health Consortium | Current | Accepting new patients | |
| Bristol Bay Area Health Corporation | Current |
Accepting new patients | |
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Bristol Bay Area Health Corportion | Current | Accepting new patients | |
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Bristol Bay Area Health Corportation | Current | Accepting new patients | |
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Bristol Bay Area Health Corportion | Current |
Accepting new patients | |
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Bristol Bay Area Health Corporation | Current | Accepting new patients |
Locations
37 Chilkat Ave
Haines, AK 99827
Phone (907) 463-4040
3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000
222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423
2043 College Way
Forest Grove, OR 97116
Phone (503) 352-2020
222 SE 8th Ave
#212
Hillsboro, OR 97123
Phone 5033522400 ext. 8060
222 SE 8th Ave
Ste 114
Hillsboro, OR 97123
Phone (503) 352-7300
1411 SW Morrison St
Ste 310
Portland, OR 97205
Interoperability endpoints
- tbuckingham315773@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4022ATI | OR | Yes |
Addresses
Primary practice location
7615 SW Speaks Dr
Gaston, OR 97119-9117
Mailing address
7615 SW Speaks Dr
Gaston, OR 97119-9117
Phone (503) 459-9247
Other providers in Gaston, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.