NPIMap

Organization Active NPI

Blue Wave Eye Doctors Professional Limited Liability Company

  • Optometrist
  • Everett, WA
National Provider Identifier
1053060475
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BLUE WAVE EYE DOCTORS PROFESSIONAL LIMITED LIABILITY COMPANY
Practice address
305 SE Everett Mall Way Ste 21
Everett, WA 98208-3250
Phone
(425) 386-8428
Fax
(425) 267-0575
NPI assigned
Mar 22, 2022
Last updated
May 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2024

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

Authorized official

Name
Dolsie McDonald
Title
Network Manager
Phone
(726) 444-4078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

305 SE Everett Mall Way Ste 21
Everett, WA 98208-3250

Mailing address

175 E Houston St
San Antonio, TX 78205-2299
Phone (726) 444-4078

Other practice location 1

921 N 10th St Ste B
Renton, WA 98057-5591
Phone (425) 255-1022

Other practice location 2

3801 S Steele St Unit A
Tacoma, WA 98409-7317
Phone (253) 317-2704

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230104002260 WA Part B Supplier - Clinic/Group Practice 5294116265 Receives reassigned benefits from 25 practitioners
Practice locations: Bellevue, WA; Everett, WA; Lynnwood, WA; Olympia, WA; Renton, WA; Seattle, WA; Silverdale, WA; Tacoma, WA…

National Provider Directory

National Provider Directory
Tax ID family
Blue Wave Eye Doctors Professional Limited Liability Company2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

340 NE Northgate Way
Seattle, WA 98125
Phone (206) 210-5963

3801 S Steele St
Unit A
Tacoma, WA 98409
Phone (253) 317-2704

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1647907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715644800000",
    "number": "1053060475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 E HOUSTON ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782052299",
            "telephone_number": "726-444-4078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 SE EVERETT MALL WAY STE 21",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982083250",
            "telephone_number": "425-386-8428",
            "fax_number": "425-267-0575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "921 N 10th St Ste B",
            "address_purpose": "LOCATION",
            "city": "Renton",
            "state": "WA",
            "postal_code": "980575591",
            "country_code": "US",
            "telephone_number": "425-255-1022",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3801 S Steele St Unit A",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984097317",
            "country_code": "US",
            "telephone_number": "253-317-2704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLUE WAVE EYE DOCTORS PROFESSIONAL LIMITED LIABILITY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-22",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "DOLSIE",
        "authorized_official_title_or_position": "NETWORK MANAGER",
        "authorized_official_telephone_number": "726-444-4078"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

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