Individual provider Active NPI

Tajinder Kaur Shergill, O.D.

  • Optometrist
  • Puyallup, WA
National Provider Identifier
1114072485
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3309TX Issued in WA
Practice address
3500 S Meridian
#345
Puyallup, WA 98373-3779
Phone
(253) 848-9620
Fax
(253) 840-8536
NPI assigned
Jan 24, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3309TX WA Primary

Addresses

Primary practice location

3500 S Meridian
#345
Puyallup, WA 98373-3779

Mailing address

3500 S Meridian
#345
Puyallup, WA 98373-3779
Phone (253) 848-9620

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20101213000709 WA Practitioner - Optometry 2365639648 Receives reassigned benefits from 1 practitioner
Practice locations: Puyallup, WA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3500 S Meridian
Suite 345
Puyallup, WA 98373-3704
Phone (253) 848-9620

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3309TXWAMDOptometrist

Practitioners & affiliated clinicians

Practitioners 1

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": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114072485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 S MERIDIAN",
            "address_2": "#345",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733779",
            "telephone_number": "253-848-9620",
            "fax_number": "253-840-8536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 S MERIDIAN",
            "address_2": "#345",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733779",
            "telephone_number": "253-848-9620",
            "fax_number": "253-840-8536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHERGILL",
        "first_name": "TAJINDER",
        "middle_name": "KAUR",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "3309TX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.