Eye Doctors Northwest PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

3816 Issued in WA

Legal business name

EYE DOCTORS NORTHWEST PLLC

Practice address

17224 SE 272ND St
Ste B
Covington, WA 98042-4953

Phone

(253) 528-3939

NPI assigned

Sep 17, 2014

Organization subpart

No

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

Authorized official

Name

Grady Hollenbeck, O.D.NPI 1134284151

Title

President

Phone

(425) 260-6428

Specialties & licenses 1

Addresses

Other names 1

• Advanced Eye Care of Covington Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Grady G Hollenbeck, O.D.

  • Optometrist
  • Covington, WA
  • NPI 1134284151
  Medicare reassignment NPD Authorized official
• Jennifer Phuong-Uyen Nguyen, O.D.

  • Optometrist
  • Bullhead City, AZ
  • NPI 1255680781

  WA

  Medicare reassignment NPD

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410912000000",
    "number": "1124420526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17224 SE 272ND ST",
            "address_2": "STE B",
            "city": "COVINGTON",
            "state": "WA",
            "postal_code": "980424953",
            "telephone_number": "253-528-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17224 SE 272ND ST",
            "address_2": "STE B",
            "city": "COVINGTON",
            "state": "WA",
            "postal_code": "980424953",
            "telephone_number": "253-528-3939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE DOCTORS NORTHWEST PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-17",
        "last_updated": "2014-09-17",
        "status": "A",
        "authorized_official_last_name": "HOLLENBECK",
        "authorized_official_first_name": "GRADY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "425-260-6428",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "3816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Eye Care of Covington",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Sue Edwards, LMP
• Leta Kaye Eilers, MA00024665
• Michele N Elder, PHARMD
• Elizabeth a Warner MD Inc PS
• Mohamed Elshazzly, DO
• Chisom Ezenwoye, PHARM. D
• Sophia Farkas
• Deidre Louise Feeney, M.D.
• Daniel Frank Fernandez, ATC
• Megan Marie Ferris

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2014; 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.