Ballard Eye Clinic PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

BALLARD EYE CLINIC PLLC

Practice address

2201 NW Market St
Seattle, WA 98107-4025

Phone

(206) 789-7417

NPI assigned

Dec 1, 2020

Organization subpart

No

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

Authorized official

Name

Eric Bergstrom, ODNPI 1588687040

Title

Owner

Phone

(206) 282-8120

Specialties & licenses 1

Addresses

Other names 1

• Northwest Vision Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 7

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

• Eric John Bergstrom, O.D.

  • Optometrist
  • Seattle, WA
  • NPI 1588687040
  Medicare reassignment Care Compare group NPD Authorized official
• Bianca Cecile Austin

  • Optometrist
  • Seattle, WA
  • NPI 1790422806
  Medicare reassignment Care Compare group NPD
• Philip S Lo, O.D.

  • Optometrist
  • Seattle, WA
  • NPI 1700841012
  Medicare reassignment Care Compare group NPD
• Stephanie Michalko

  • Optometrist
  • Kirkland, WA
  • NPI 1629568928
  Medicare reassignment Care Compare group NPD
• Chelsie Michelle Russ, O.D.

  • Optometrist
  • Seattle, WA
  • NPI 1376950212
  Medicare reassignment Care Compare group NPD
• Charanpreet Samra, OD

  • Optometrist
  • Redmond, WA
  • NPI 1730827445
  Medicare reassignment NPD
• Kristen Chippi, O.D.

  • Optometrist
  • Traverse City, MI
  • NPI 1164971966
  NPD

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

{
    "created_epoch": "1606780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606780800000",
    "number": "1083219752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 BOSTON ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981092319",
            "telephone_number": "206-282-8120",
            "fax_number": "206-282-8046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 NW MARKET ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981074025",
            "telephone_number": "206-789-7417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALLARD EYE CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-01",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A",
        "authorized_official_last_name": "BERGSTROM",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-282-8120",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ballard Avenue Psychiatry PLLC
• Ballard Central Chiropractic Inc
• Ballard Central Massage Clinic LLC
• Ballard Chiropractic Clinic, PS
• Ballard Emergency Physicians, P.S.
• Ballard Health Center
• Ballard Neighborhood Doctors PLLC
• Ballard OBGYN, P.C.
• Ballard Optical PS
• Ballard Optometry, PLLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; 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.