Organization Active NPI

Eye MDS of Puget Sound PLLC

  • Ophthalmology Physician
  • Tacoma, WA
National Provider Identifier
1003858358
Registry record updated Feb 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
EYE MDS OF PUGET SOUND PLLC
Practice address
4707 S 19TH St
Suite 210
Tacoma, WA 98405-1151
Phone
(253) 272-4600
Fax
(253) 272-6289
NPI assigned
Jun 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Melinda Blackwell
Title
Administrator
Phone
(253) 442-2234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

4707 S 19TH St
Suite 210
Tacoma, WA 98405-1151

Mailing address

4707 S 19TH St
Suite 210
Tacoma, WA 98405-1151
Phone (253) 272-4600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040331000524 WA Part B Supplier - Clinic/Group Practice 4981696952 Receives reassigned benefits from 8 practitioners
Practice locations: Tacoma, WA

National Provider Directory

National Provider Directory

Locations

4707 S 19th St
Ste 210
Tacoma, WA 98405
Phone (253) 248-2020

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707868800000",
    "number": "1003858358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4707 S 19TH ST",
            "address_2": "SUITE 210",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984051151",
            "telephone_number": "253-272-4600",
            "fax_number": "253-272-6289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4707 S 19TH ST",
            "address_2": "SUITE 210",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984051151",
            "telephone_number": "253-272-4600",
            "fax_number": "253-272-6289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE MDS OF PUGET SOUND PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A",
        "authorized_official_last_name": "BLACKWELL",
        "authorized_official_first_name": "MELINDA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "253-442-2234"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.