Individual provider Active NPI

Manraj Sidhu

  • Optometrist
  • Stanwood, WA
National Provider Identifier
1124999529
Registry record updated Sep 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD.OD.70031275 Issued in WA
Practice address
9606 271St St NW
Stanwood, WA 98292-8096
Phone
(360) 939-0604
NPI assigned
Sep 17, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD.OD.70031275 WA Primary

Addresses

Primary practice location

9606 271St St NW
Stanwood, WA 98292-8096

Mailing address

9606 271St St NW
Stanwood, WA 98292-8096
Phone (360) 939-0604

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
I20251211004280 WA Practitioner - Optometry 2264926609 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Village Eye Care LLC 2 clinicians

Practice addresses (Care Compare)

9606 271St St NW
Stanwood, WA 98292-8096
Phone (360) 939-0604

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OD.OD.70031275WAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Village Eye Care, LLC Optometrist CurrentSince Oct 3, 2025 Accepting new patients

Locations

9606 271st St NW
Stanwood, WA 98292
Phone (360) 939-0604

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1758067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758067200000",
    "number": "1124999529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9606 271ST ST NW",
            "city": "STANWOOD",
            "state": "WA",
            "postal_code": "982928096",
            "telephone_number": "360-939-0604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9606 271ST ST NW",
            "city": "STANWOOD",
            "state": "WA",
            "postal_code": "982928096",
            "telephone_number": "360-939-0604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDHU",
        "first_name": "MANRAJ",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-09-17",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD.OD.70031275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanwood, WA

Sources for this page

Verify at the official NPI Registry.