EYE DEPARTMENT
NPI 1124466545
Optometrist in Portland, OR

Q: What is Urban Eye Gallery, LLC's NPI number?

The NPI number for Urban Eye Gallery, LLC is 1124466545. It was assigned to this organization in the NPPES registry on June 7, 2013. The provider is doing business as Eye Department.

Q: What is Urban Eye Gallery, LLC's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Active since June 07, 2013CLIA 38D2344428 · Waiver

921 SW 16TH AVE, PORTLAND, OR 97205(503) 227-0573 Get Directions Write a Review

NPPES record last updated: June 7, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Eye Department NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EYE DEPARTMENT (NPI 1124466545) is a healthcare organization registered as an optometrist in Portland, Oregon and active in the NPI registry since June 2013. The organization holds a CLIA Waiver certificate valid through May 20, 2028 and lists Anita Phromsivarak Bacon, Managing Member, as its authorized official.

NPPES Registry Identity

NPI1124466545

Entity TypeOrganization

Primary Taxonomy152W00000X

Legal Business NameURBAN EYE GALLERY, LLC

Location Address921 SW 16TH AVEPortland, OR 97205-1730

Mailing Address921 Sw 16th AvePortland, OR 97205-1730 · (503) 227-0573

Phone(503) 227-0573

Organization SubpartNo

Authorized OfficialAnita Phromsivarak BaconManaging Member · (503) 227-0573

Enumeration DateJune 7, 2013

✔ NPI 1124466545 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers

Taxonomy Code152W00000X

License✔ Licensed in OR · 3195 ATI

Definition

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

921 SW 16TH AVE, Portland, OR 97205

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Other Names 1

Doing Business AsEye Department

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BlueCross BlueShield of Tennessee, PacificSource Health Plans, Providence Health Plan.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 38D2344428

Urban Eye Gallery, LLC Dba Eye Department · Portland, OR

Active · expires May 20, 2028

CLIA Number38D2344428

Laboratory TypePhysician Office

Certificate Effective DateMay 21, 2026

Certificate Expiration DateMay 20, 2028

Laboratory DirectorAnita P. Bacon

Laboratory Phone(503) 227-0573

Laboratory LocationUrban Eye Gallery, LLC Dba Eye Department921 SW 16th Avenue, Portland, OR 97205

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANITA (ANNIE) PHROMSIVARAK BACON O.D.

Optometrist

921 SW 16TH AVE
PORTLAND, OR 97205

Multnomah County (503) 227-0573

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Urban Eye Gallery, LLC's NPI number?

The NPI number for Urban Eye Gallery, LLC is 1124466545. It was assigned to this organization in the NPPES registry on June 7, 2013. The provider is doing business as Eye Department.

Where is Urban Eye Gallery, LLC located?

Urban Eye Gallery, LLC is located at 921 SW 16th Ave, Portland, OR 97205. The listed phone number is (503) 227-0573.

What is Urban Eye Gallery, LLC's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Does Urban Eye Gallery, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 38D2344428) is associated with this NPI, valid through May 20, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Urban Eye Gallery, LLC accept?

Health plans from BlueCross BlueShield of Tennessee, PacificSource Health Plans and Providence Health Plan list Urban Eye Gallery, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Urban Eye Gallery, LLC was last updated on June 7, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.