Stacey Keppol, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD60840014 Issued in WA

Practice address

2606 116TH Ave NE Ste 100
Bellevue, WA 98004-1422

Phone

(425) 462-7664

NPI assigned

Jul 3, 2013

Sex

Female

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 2

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

New England College of Optometry, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pacific Cataract and Laser Institute Inc PCGroup PAC ID 7517864119, 75 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: stacey.keppol.p1@direct.pcli.nextgenshare.com

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

• Pacific Cataract and Laser Institute Inc PC

  • Ambulatory Surgical Clinic/Center
  • Bellevue, WA
  • NPI 1306013925
  Medicare reassignment Care Compare group NPD
• Pacific Cataract and Laser Institute Inc PC

  • Ambulatory Surgical Clinic/Center
  • Chehalis, WA
  • NPI 1487821633
  NPD
• Pacific Cataract and Laser Institute Inc PC

  • Ambulatory Surgical Clinic/Center
  • Vancouver, WA
  • NPI 1659548329
  NPD
• Pacific Cataract and Laser Institute, Inc., P.C.

  • Ophthalmologic Surgery Clinic/Center
  • Auburn, WA
  • NPI 1528814647
  NPD
• Pacific Cataract and Laser Institute, Inc., P.C.

  • Ambulatory Surgical Clinic/Center
  • Kennewick, WA
  • NPI 1619144607
  NPD
• Pacific Cataract and Laser Institute, Inc., P.C.

  • Ambulatory Surgical Clinic/Center
  • Chehalis, WA
  • NPI 1114978848
  NPD (past)
• Pacific Cataract and Laser Institute, Inc., P.C.

  • Ambulatory Surgical Clinic/Center
  • Lacey, WA
  • NPI 1215178835
  NPD (past)

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

{
    "created_epoch": "1372809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1093155103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1506",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985320409",
            "telephone_number": "360-242-3010",
            "fax_number": "206-858-7050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2606 116TH AVE NE STE 100",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980041422",
            "telephone_number": "425-462-7664"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10330 Meridian Ave N Ste 370",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981339463",
            "country_code": "US",
            "telephone_number": "206-528-6000",
            "fax_number": "206-528-0014",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 W Godfrey Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191413323",
            "country_code": "US",
            "telephone_number": "215-276-6000 x6000",
            "fax_number": "215-276-1329",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 W Godfrey Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191413323",
            "country_code": "US",
            "telephone_number": "215-276-6000 x6000",
            "fax_number": "215-276-1329",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEPPOL",
        "first_name": "STACEY",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-03",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60840014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2096921",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH PROVIDER NUMBER",
            "identifier": "12564332",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kent G Leavitt MD PLLC
• Gerald G. Kent, M.D.
• Sadie Kent
• Stephanie Kent, L.M.P.
• Monique Serina Keo
• Yumi Kerametlian
• Sarah Ruth Kermgard, LICSW
• Abbi Kern, DPT
• Jana Kessler
• Jennifer Lynn Kessler, LMT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; 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.