NPIMap

Organization Active NPI

Enumclaw Vision Clinic PLLC

  • Optometrist
  • Enumclaw, WA
National Provider Identifier
1043718257
Registry record updated Jan 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1260 Issued in WA
Legal business name
ENUMCLAW VISION CLINIC PLLC
Practice address
2823 Griffin Ave
Enumclaw, WA 98022-2322
Phone
(360) 825-1614
Fax
(360) 825-8034
NPI assigned
Jan 23, 2018
Last updated
Jan 23, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2018

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

Authorized official

Name
Mark A Seaburg, ODNPI 1720195910
Title
Employee
Phone
(360) 825-1614

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
Optometrist 152W00000X 1260 WA Primary

Addresses

Primary practice location

2823 Griffin Ave
Enumclaw, WA 98022-2322

Mailing address

2823 Griffin Ave
Enumclaw, WA 98022-2322
Phone (360) 825-1614

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1516665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516665600000",
    "number": "1043718257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2823 GRIFFIN AVE",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980222322",
            "telephone_number": "360-825-1614",
            "fax_number": "360-825-8034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2823 GRIFFIN AVE",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980222322",
            "telephone_number": "360-825-1614",
            "fax_number": "360-825-8034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENUMCLAW VISION CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-23",
        "last_updated": "2018-01-23",
        "status": "A",
        "authorized_official_last_name": "SEABURG",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EMPLOYEE",
        "authorized_official_telephone_number": "360-825-1614",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "1260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enumclaw, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.