Optum Care Washington PLLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

CF00056689 Issued in WA

Legal business name

OPTUM CARE WASHINGTON PLLC

Practice address

4410 106TH St SW
Mukilteo, WA 98275-4700

Phone

(425) 493-6005

Fax

(425) 493-6035

NPI assigned

Nov 8, 2006

Organization subpart

No

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

Authorized official

Name

George Go, M.D.

Title

Board President

Phone

(425) 258-3900

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Optum - PHCY Harbour Pointe Other name

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Optum Care Washington PLLC

  • Durable Medical Equipment & Medical Supplies
  • Mukilteo, WA
  • NPI 1245380260

  O20110119000304

  Same enrollment

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

• North Puget Sound Center for Sleep Disorders

  • Sleep Disorder Diagnostic Clinic/Center
  • Everett, WA
  • NPI 1194771402

  Member Of

  NPD member
• Refuge Dialysis LLC

  dba Everett Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Everett, WA
  • NPI 1194048702

  Member Of

  NPD member
• Refuge Dialysis LLC

  dba Pilchuck Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Marysville, WA
  • NPI 1740696848

  Member Of

  NPD member

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712534400000",
    "number": "1114097292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2747",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982130747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 106TH ST SW",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982754700",
            "telephone_number": "425-493-6005",
            "fax_number": "425-493-6035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUM CARE WASHINGTON PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A",
        "authorized_official_last_name": "GO",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "BOARD PRESIDENT",
        "authorized_official_telephone_number": "425-258-3900",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WA",
            "license": "CF00056689",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6008841",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4920460",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optum - PHCY Harbour Pointe",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kale James Olson, PT, DPT
• Leamlake Lea Olson
• Tamra Olson
• Roger B. Olsson, M.D.
• Kathryn T Onishi, DDS
• Optum Care Washington PLLC
• Tomichyne Osborne
• Pacific Eyecare Professionals Inc (advanced eyecare of mukilteo)
• Rajasri Dharani Palepu, MD
• Leela Pannu, DOCTOR OF PHARMACY

• Pharmacy in Mukilteo, WA
• Providers in Mukilteo, WA by specialty
• Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.