NPIMap

Organization Active NPI

Eric Bergstrom OD, PLLC

Doing business as Eye Clinics of Seattle - Roosevelt

  • Optometrist
  • Seattle, WA
National Provider Identifier
1124289897
Registry record updated May 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3645 Issued in WA
Legal business name
ERIC BERGSTROM OD, PLLC
Doing business as
Eye Clinics of Seattle - Roosevelt
Queen Anne Eye Clinic
Practice address
20 Boston St
Seattle, WA 98109-2319
Phone
(206) 282-8120
Fax
(206) 282-8046
NPI assigned
Jun 24, 2008
Last updated
May 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2023

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

Authorized official

Name
Dr. Eric John BergstromNPI 1588687040
Title
Owner
Phone
(206) 282-8120

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 3645 WA Primary

Addresses

Primary practice location

20 Boston St
Seattle, WA 98109-2319

Mailing address

20 Boston St
Seattle, WA 98109-2319
Phone (206) 282-8120

Other practice location 1

6618 Roosevelt Way NE
Seattle, WA 98115-6607
Phone (206) 282-8120

Other names 2

  • Eye Clinics of Seattle - Roosevelt Doing business as
  • Queen Anne Eye Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091215000440 WA Part B Supplier - Clinic/Group Practice 0941190417 Receives reassigned benefits from 13 practitioners
Practice locations: Seattle, WA

National Provider Directory

National Provider Directory

Locations

607 W McGraw St
Seattle, WA 98119
Phone (206) 282-8120

6618 Roosevelt Way NE
Seattle, WA 98115
Phone (206) 282-8120

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683504000000",
    "number": "1124289897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 BOSTON ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981092319",
            "telephone_number": "206-282-8120",
            "fax_number": "206-282-8046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 BOSTON ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981092319",
            "telephone_number": "206-282-8120",
            "fax_number": "206-282-8046"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6618 Roosevelt Way NE",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981156607",
            "country_code": "US",
            "telephone_number": "206-282-8120",
            "fax_number": "206-282-8046",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ERIC BERGSTROM OD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-24",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A",
        "authorized_official_last_name": "BERGSTROM",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-282-8120",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "3645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Clinics of Seattle - Roosevelt",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Queen Anne Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Queen Anne Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; 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.