Family Vision of Oregon PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1494ATI Issued in OR

Legal business name

FAMILY VISION OF OREGON PC

Practice address

51675 N Columbia River Hwy
Scappoose, OR 97056

Phone

(503) 543-6313

Fax

(503) 543-6349

NPI assigned

Jul 6, 2007

Last updated

Jul 28, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Daniel L Mannen, ODNPI 1609831973

Title

Owner

Phone

(503) 543-6313

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Family Vision of Oregon PC

  • Optometrist
  • Saint Helens, OR
  • NPI 1952515918

  7517956386

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Family Vision of Oregon PC

  • Optometrist
  • Saint Helens, OR
  • NPI 1952515918

  O20040507000407

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Family Vision of Oregon PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Family Vision of Oregon PC

  • Optometrist
  • Saint Helens, OR
  • NPI 1952515918
  NPD tax ID

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daniel Leroy Mannen, O.D.

  • Optometrist
  • Saint Helens, OR
  • NPI 1609831973
  NPD Authorized official
• Sarah Chewerda, O.D.

  • Optometrist
  • Saint Helens, OR
  • NPI 1306037098
  NPD
• Thomas A Chewerda, O.D.

  • Optometrist
  • Saint Helens, OR
  • NPI 1164652590
  NPD
• Lena Hanae Walker, O.D.

  • Optometrist
  • Saint Helens, OR
  • NPI 1831127398
  NPD
• Laurel Gillette Mannen, O.D.

  • Optometrist
  • Saint Helens, OR
  • NPI 1467553693
  NPD (past)
• Michael Sukkyu Kim, O.D.

  • Optometrist
  • Vista, CA
  • NPI 1164546313
  NPD (past)

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

{
    "created_epoch": "1183680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217203200000",
    "number": "1992903454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1228",
            "city": "SCAPPOOSE",
            "state": "OR",
            "postal_code": "970561228",
            "telephone_number": "503-543-6313",
            "fax_number": "503-543-6349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51675 N COLUMBIA RIVER HWY",
            "city": "SCAPPOOSE",
            "state": "OR",
            "postal_code": "97056",
            "telephone_number": "503-543-6313",
            "fax_number": "503-543-6349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY VISION OF OREGON PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-06",
        "last_updated": "2008-07-28",
        "status": "A",
        "authorized_official_last_name": "MANNEN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-543-6313",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1494ATI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127704",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.