Bonney Lake Optical, Inc

Primary specialty

Pediatric OptometristTaxonomy code 152WP0200X

Legal business name

BONNEY LAKE OPTICAL, INC

Practice address

19205 State Route 410 E
Bonney Lake, WA 98391-6305

Phone

(253) 826-9156

Fax

(253) 826-9158

NPI assigned

Jan 4, 2007

Organization subpart

No

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

Authorized official

Name

Sean Cudahy, ODNPI 1841641719

Title

Cfo

Phone

(253) 750-8135

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Emerald Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Tax ID family

Bonney Lake Optical2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bonney Lake Optical, Inc

  • Optometrist
  • Bonney Lake, WA
  • NPI 1902953581
  NPD tax ID

Locations

Practitioners 6

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

• Sean Cudahy, O.D.

  • Pediatric Optometrist
  • Bonney Lake, WA
  • NPI 1841641719
  Medicare reassignment Care Compare group NPD Authorized official
• Bruce Gerald Cudahy, O.D.

  • Optometrist
  • Bonney Lake, WA
  • NPI 1457321135
  Medicare reassignment Care Compare group NPD
• Ryan Beck

  • Optometrist
  • Kent, WA
  • NPI 1104289792
  Medicare reassignment NPD
• Jasonpreet Dhaliwal, OD

  • Optometrist
  • Issaquah, WA
  • NPI 1972176006
  Medicare reassignment NPD
• Mahin Khadeer, O.D

  • Optometrist
  • Bellevue, WA
  • NPI 1306585179
  Medicare reassignment NPD
• Prabhdeep Sahota

  • Optometrist
  • Federal Way, WA
  • NPI 1801411574
  Medicare reassignment NPD

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788307200000",
    "number": "1154478014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2139",
            "city": "ORTING",
            "state": "WA",
            "postal_code": "983602139",
            "telephone_number": "253-826-9156",
            "fax_number": "253-826-9158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19205 STATE ROUTE 410 E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983916305",
            "telephone_number": "253-826-9156",
            "fax_number": "253-826-9158"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "743 Rainier Ave S",
            "address_purpose": "LOCATION",
            "city": "Renton",
            "state": "WA",
            "postal_code": "980573204",
            "country_code": "US",
            "telephone_number": "425-227-9170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BONNEY LAKE OPTICAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A",
        "authorized_official_last_name": "CUDAHY",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "253-750-8135",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WA",
            "license": "1641",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2009926",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emerald Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Bonney Lake Physical Therapy and Hand Rehab, PLLC
• Billy Boraphet

• Pediatric Optometrist in Bonney Lake, WA
• Providers in Bonney Lake, WA by specialty
• Pediatric Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; 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.