Dr. Bret A. Provost, O.D.
Optometrist in Clackamas, OR. Individual provider (NPI-1).
NPI number1528093556
StatusActive
Last updated in NPPESMay 4, 2010
Details
- NPI
- 1528093556
- Entity type
- Individual (NPI-1)
- Name
- Dr. Bret A. Provost
- Credential
- O.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 11, 2006
- Last updated
- May 4, 2010
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - OPTOMETRY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 3132 | OR | Yes |
Practice location
9201 Se 91st AveSuite 210
Clackamas, OR 97086-3760
Phone 503-775-2424 · Fax 503-775-6181
Mailing address
9201 Se 91st AveSuite 210
Clackamas, OR 97086-3760
Phone 503-775-2424 · Fax 503-775-6181
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 21 Optometrist providers in Clackamas · All 2,438 providers in Clackamas
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