AEG OREGON PROFESSIONAL LLC — NPI 1679253397 (Licensed & Credentialed Eye and Vision Service Providers

CMS-1500 Box 24J / 33a • NPI

1679253397

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

152W00000X (CMS 41)

Licensed & Credentialed Eye and Vision Service Providers — Optometrist

Box 32 Service Location & ZIP+4

990 BROADWAY ST NE STE 100, SALEM, OR, 97301-1396

✓ 9-Digit EDI 837 ZIP+4 (97301-1396)

Practice Phone & Referral Fax

(503) 364-0767

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1679253397 (AEG OREGON PROFESSIONAL LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1679253397` (NPI-2 Organization / Facility)
Provider / Legal Name	AEG OREGON PROFESSIONAL LLC
Plain-English Specialty	Licensed & Credentialed Eye and Vision Service Providers — Optometrist NUCC Code: `152W00000X` (Optometrist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	990 BROADWAY ST NE STE 100, SALEM, OR, 97301-1396
Practice Telephone / Fax	Tel: (503) 364-0767
Administrative Mailing Address	111 E 4TH ST STE 440, ALTON, IL, 62002-6206
Enumeration & Last Sync	Enumerated: 2023-07-18 \| CMS Record Updated: 2024-06-20
Authorized Official	MELISSA ALLISON (Sr. Director RCM/MVC)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

990 BROADWAY ST NE STE 100, SALEM, OR, 97301-1396

🗺️ Open in Google Maps 🏥 More Providers in SALEM

🔒 Are you AEG OREGON PROFESSIONAL LLC? Get your Verified NPI Clinic Badge or request personal phone/address redaction →

Plain-English Taxonomy & CMS Crosswalk (152W00000X)

What Does Taxonomy Code 152W00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 152W00000X translates to:
"Licensed & Credentialed Eye and Vision Service Providers — Optometrist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 41 (Optometry)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Optometrist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (AEG OREGON PROFESSIONAL LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`152W00000X` — Optometrist Plain English: Licensed & Credentialed Eye and Vision Service Providers — Optometrist	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.

Launch Bulk NPI Checker → JSON API Docs

AEG OREGON PROFESSIONAL LLC (NPI #1679253397)