NPIMap

Organization Active NPI

Mountain View Eye Care Center P C

  • Optometrist
  • Vancouver, WA
National Provider Identifier
1093035305
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MOUNTAIN VIEW EYE CARE CENTER P C
Practice address
1405 SE 164TH Ave Ste 102
Vancouver, WA 98683-9644
Phone
(360) 253-4405
NPI assigned
Jun 9, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Authorized official

Name
Dr. Nicholas Jankowski, ODNPI 1659766004
Title
Owner
Phone
(360) 253-4405

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X
Low Vision Rehabilitation OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WL0500X
Pediatric OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WP0200X

Addresses

Primary practice location

1405 SE 164TH Ave Ste 102
Vancouver, WA 98683-9644

Mailing address

14415 SE Mill Plain Blvd
Ste. 115-B
Vancouver, WA 98684-3543
Phone (360) 253-4405

Other identifiers 2

IdentifierTypeStateIssuer
2008217MedicaidWA
2024081MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100708000985 WA Part B Supplier - Clinic/Group Practice 6103957196 Receives reassigned benefits from 5 practitioners
Practice locations: Vancouver, WA

National Provider Directory

National Provider Directory

Locations

14415 SE Mill Plain Blvd
Ste 115B
Vancouver, WA 98684
Phone (360) 253-4405

14415 SE Mill Plain Blvd
Ste 115
Vancouver, WA 98684

Practitioners & affiliated clinicians

Practitioners 5

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": "1276041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1093035305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14415 SE MILL PLAIN BLVD",
            "address_2": "STE. 115-B",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986843543",
            "telephone_number": "360-253-4405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 SE 164TH AVE STE 102",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986839644",
            "telephone_number": "360-253-4405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN VIEW EYE CARE CENTER P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-09",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A",
        "authorized_official_last_name": "JANKOWSKI",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-253-4405",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2008217",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2024081",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.