Ray George Hedahl, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD00001086 Issued in WA

Practice address

19220 8TH Ave NE Ste a
Poulsbo, WA 98370-8773

Phone

(360) 779-2336

Fax

(360) 779-7628

NPI assigned

Aug 29, 2006

Last updated

Jun 11, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kitsap Eyecare Centers Inc PSGroup PAC ID 2264320894, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kitsap Eyecare Centers Inc PS

  dba Poulsbo Eyecare Center

  • Optometrist
  • Poulsbo, WA
  • NPI 1477612463
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623369600000",
    "number": "1053420851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19220 8TH AVE NE STE A",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983708773",
            "telephone_number": "360-779-2336",
            "fax_number": "360-779-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19220 8TH AVE NE STE A",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983708773",
            "telephone_number": "360-779-2336",
            "fax_number": "360-779-7628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEDAHL",
        "first_name": "RAY",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00001086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2030054",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KPS HEALTH PLANS",
            "identifier": "91155102306",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD",
            "identifier": "HE0975",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA BLUE CROSS",
            "identifier": "23835",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wendy Zeeben Hawley, MD
• Lauren Hayes, PHD
• Healing Foundations Therapy LLC
• Hearing Advantage Inc
• Heather Blackmore Ma Lmfta
• Brittany Leeann Hedin, COTA
• Jeremiah Heebink, LMP
• Aurora Hein
• Lindsay Marie Hendricks, O.D.
• Robin Hendricks, LMP

• Optometrist in Poulsbo, WA
• Providers in Poulsbo, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.