DR. JENNIFER CAROL PRUNTY (NPI# 1164738795) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164738795 |
| Entity Type | Individual |
| Full Name | DR. JENNIFER CAROL PRUNTY |
| Other Name | DR. JENNIFER CAROL SINCLAIR |
| Credential | O.D. |
| Practice Address |
300 N Graham St Suite 300 Portland OR 97227-1683 |
| Mailing Address |
4202 Sw Corbett Ave Portland OR 97239-4259 |
| Practice Telephone | 5034133030 |
| Practice Fax Number | 5034133113 |
| Mailing Telephone | 7348126186 |
| Mailing Fax Number | 5034133113 |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2014-07-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 3436AT | OR | Eye and Vision Services Providers |
| N | 152W00000X | Optometrist | OPC 4547 | FL | Eye and Vision Services Providers |
| Street Address |
300 N GRAHAM ST SUITE 300 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97227-1683 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952305385 | Elise Jan Fulsang | Internal Medicine | 300 N Graham St, Suite 200, Portland, OR 97227-1683 | 2005-06-13 |
| 1598186736 | Meaghen Murphy | Social Worker | 300 N Graham St, Suite 100, Portland, OR 97227-1683 | 2013-12-13 |
| 1952669863 | Jaellah Thalberg | Genetic Counselor, MS | 300 N Graham St, Suite 100, Portland, OR 97227-1683 | 2012-04-27 |
| 1720311996 | Kimberly Hillis | Physical Medicine & Rehabilitation | 300 N Graham St, Suite 430, Portland, OR 97227-1683 | 2009-09-04 |
| 1710129184 | Melissa Anne Sheiko | Pediatrics | 300 N Graham St, Suite 420, Portland, OR 97227-1683 | 2009-04-01 |
| 1568623072 | Raghu U Varier | Pediatrics | 300 N Graham St, Suite 420, Portland, OR 97227-1683 | 2008-06-18 |
| 1154591519 | Steven Blake Colson | Pediatrics | 300 N Graham St, Suite 420, Portland, OR 97227-1683 | 2008-03-01 |
| 1609069525 | Patricia Anne Robertson | Obstetrics & Gynecology | 300 N Graham St, Suite 100, Portland, OR 97227-1683 | 2007-08-23 |
| 1548467129 | Northwest Pediatric Gastroenterology, LLC | Specialist | 300 N Graham St, Suite 420, Portland, OR 97227-1683 | 2007-06-28 |
| 1659574648 | Amy Doss Bednar | Obstetrics & Gynecology | 300 N Graham St, Suite 100, Portland, OR 97227-1683 | 2007-06-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508466574 | Jessica Michelle Simonetti | Psychologist | Portland Psychotherapy Clinic, Research and Training Ce, 3700 N Williams Ave, Portland, OR 97227 | 2020-10-29 |
| 1447812268 | Maksim Yefimov | Physician Assistant | 2800 N Vancouver Ave Ste 130, Portland, OR 97227 | 2019-07-01 |
| 1851955975 | Erin Marie Staples | Student in an Organized Health Care Education/Training Program | 2800 N. Vancouver Ave;, Suite 230, Portland, OR 97227 | 2019-04-24 |
| 1922588508 | Melanie Grace Mix | Physician Assistant | 501 N Graham St Ste 420, Portland, OR 97227 | 2018-08-14 |
| 1730615071 | Mehran Giblin | Student in an Organized Health Care Education/Training Program | 2800 N. Vancouver Ave, Suite 230, Legacy Clinic Emanuel, Portland, OR 97227 | 2017-05-05 |
| 1730623687 | Christina Grace Belter | Optometrist | 300 N Graham St Ste 300, Portland, OR 97227 | 2016-12-12 |
| 1407300205 | Jenna Abernathy | Counselor | 3537 N Williams Ave, Portland, OR 97227 | 2016-08-09 |
| 1215390760 | Tanya Marie Woods | Massage Therapist | 3808 N. Williams Ave., Portland, OR 97227 | 2016-04-01 |
| 1033596853 | Eric Allen Martin | Counselor | 2054 N. Vancouver Ave, Portland, OR 97227 | 2015-04-30 |
| 1285040436 | Berk Neurosurgical LLC | Neurological Surgery | 501 N Graham St Ste 500, Portland, OR 97227 | 2014-07-09 |
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| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| 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. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376162008 | Eyestrong, LLC | Optometrist | 3934 Ne Mlk Jr Blvd Ste 101, Portland, OR 97212-1153 | 2020-04-13 |
| 1740816768 | Allison Kuo | Optometrist | 3710 Sw Us Veterans Hospital Rd Bldg 1008c140, Portland, OR 97239-2964 | 2020-03-21 |
| 1689235160 | Maja Krsmanovic | Optometrist | 14 Buca Run, Portland, ME 04103-1427 | 2019-06-25 |
| 1407416225 | Sarah Fowler | Optometrist | 605 S Broadway St, Portland, TN 37148-1619 | 2019-06-14 |
| 1720645302 | Ryan Steve Kucala | Optometrist | 520 Nw Lost Springs Ter # Unite203, Portland, OR 97229-6655 | 2019-05-20 |
| 1023575925 | Pacific Eye Group, PC | Optometrist | 1006 Lloyd Ctr, Portland, OR 97232-1266 | 2019-02-27 |
| 1811472749 | Carole Tong | Optometrist | 8136 Se Foster Rd Ste 260, Portland, OR 97206-4288 | 2018-09-26 |
| 1528580354 | Dr. Han Tran & Associates, P.C. | Optometrist | 12100 Se 82nd Ave, Portland, OR 97086-7755 | 2017-07-13 |
| 1306384128 | Daniel & Max, LLC | Optometrist | 8795 Sw Scholls Ferry Rd, Portland, OR 97223-4409 | 2017-02-01 |
| 1730623687 | Christina Grace Belter | Optometrist | 300 N Graham St Ste 300, Portland, OR 97227 | 2016-12-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.