OrganizationActive
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NPI 1245687524 · Optometrist · Portland, OR
Provider details
- NPI number
- 1245687524
- Entity type
- Organization
- Primary specialty
- OptometristEye and Vision Services Providers
- Organization subpart
- No
- Authorized official
- Mary Walker, Group Billing Manager(248) 354-7100
Specialties & taxonomies
Eye and Vision Services Providers
Profile Score
Established profile(72/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
10 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
920 Nw 23rd Ave
Portland, OR 97210-3006
Phone: (503) 889-9020
Fax: (503) 889-9015
Street-level locationGet directions
Mailing address
19800 W 8 Mile Rd
Southfield, MI 48075-5730
Registry dates
- Enumerated
- 2016-05-17
- Last updated
- 2016-05-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.