NPIMap

Organization Active NPI

Whidbey Vision Care Inc PS

  • Optometrist
  • Freeland, WA
National Provider Identifier
1124199435
Registry record updated Apr 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD00003150 Issued in WA
Legal business name
WHIDBEY VISION CARE INC PS
Practice address
1690 Main St
Ste 103
Freeland, WA 98249
Phone
(360) 331-8424
Fax
(360) 331-8425
NPI assigned
Nov 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2016

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

Authorized official

Name
Holli Johnson
Title
Administrator
Phone
(360) 675-2235

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OD00003150 WA Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OD00003987 WA
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OD00004139 WA

Addresses

Primary practice location

1690 Main St
Ste 103
Freeland, WA 98249

Mailing address

PO Box 1048
Freeland, WA 98249-1048
Phone (360) 331-8424

Other identifiers 2

IdentifierTypeStateIssuer
2006765MedicaidWA
2031367MedicaidWA

National Provider Directory

National Provider Directory

Locations

1690 Main St
Freeland, WA 98249
Phone (360) 331-8424

Practitioners & affiliated clinicians

Practitioners 10

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": "1163116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459987200000",
    "number": "1124199435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1048",
            "city": "FREELAND",
            "state": "WA",
            "postal_code": "982491048",
            "telephone_number": "360-331-8424",
            "fax_number": "360-331-8425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 MAIN ST",
            "address_2": "STE 103",
            "city": "FREELAND",
            "state": "WA",
            "postal_code": "98249",
            "telephone_number": "360-331-8424",
            "fax_number": "360-331-8425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHIDBEY VISION CARE INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-10",
        "last_updated": "2016-04-07",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "HOLLI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "360-675-2235"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00003150",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00003987",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00004139",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2006765",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2031367",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Freeland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.