Madras Vision Source PC
NPI 1164791414ActiveOrganization· Optometrist· Madras, OR
Optometrist in Madras, Oregon, registered in NPPES in December 2011, part of Madras Vision Source PC. The authorized official on file is Jessica Brooke Tegan, OD, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1164791414 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Madras Vision Source PC |
| NPI issued | Dec 15, 2011 |
| Last updated in NPPES | May 17, 2022 |
| Certified by provider | May 17, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Optometrist Primary | 152W00000X | 3215ATI | OR |
| Eyewear Supplier (Equipment, not the service) | 332H00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (OR) |
|---|
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