NPIMap

Organization Active NPI

Brent Chin OD Inc PS

  • Corneal and Contact Management Optometrist
  • Federal Way, WA
National Provider Identifier
1003970823
Registry record updated Jun 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Corneal and Contact Management OptometristTaxonomy code 152WC0802X
License
OD00003778TX Issued in WA
Legal business name
BRENT CHIN OD INC PS
Practice address
32717 1St Ave S
Ste.6
Federal Way, WA 98003-5758
Phone
(253) 838-5428
Fax
(253) 838-0875
NPI assigned
Dec 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2008

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

Authorized official

Name
Brent ChinNPI 1598751349
Title
President
Phone
(253) 838-5428

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152WC0802X OD00003778TX WA Primary

Addresses

Primary practice location

32717 1St Ave S
Ste.6
Federal Way, WA 98003-5758

Mailing address

32717 1St Ave S
Ste.6
Federal Way, WA 98003-5758
Phone (253) 838-5428

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070315000285 WA Part B Supplier - Clinic/Group Practice 7214030097 Receives reassigned benefits from 5 practitioners
Practice locations: Federal Way, WA
O20100930069145 WA DME Supplier - Physician - Optometrist 7214030097 Practice locations: Federal Way, WA

National Provider Directory

National Provider Directory

Locations

32717 1st Ave S
Federal Way, WA 98003
Phone (253) 237-3042

Practitioners & affiliated clinicians

Practitioners 10

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": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212710400000",
    "number": "1003970823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32717 1ST AVE S",
            "address_2": "STE.6",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980035758",
            "telephone_number": "253-838-5428",
            "fax_number": "253-838-0875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32717 1ST AVE S",
            "address_2": "STE.6",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980035758",
            "telephone_number": "253-838-5428",
            "fax_number": "253-838-0875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENT CHIN OD INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2008-06-06",
        "status": "A",
        "authorized_official_last_name": "CHIN",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-838-5428"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "WA",
            "license": "OD00003778TX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2008; 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.