Organization Active NPI

Hoquiam Vision Clinic PS

  • Optometrist
  • Hoquiam, WA
National Provider Identifier
1164611133
Registry record updated Jun 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD00001404 Issued in WA
Legal business name
HOQUIAM VISION CLINIC PS
Practice address
403 7TH St
Hoquiam, WA 98550-3615
Phone
(360) 533-7395
Fax
(360) 532-6907
NPI assigned
Oct 16, 2007
Last updated
Jun 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2008

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

Authorized official

Name
Dr. Edward J Wayman, O.D.NPI 1508820408
Title
Optometrist
Phone
(360) 533-7395

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 OD00001404 WA Primary

Addresses

Primary practice location

403 7TH St
Hoquiam, WA 98550-3615

Mailing address

403 7TH St
Hoquiam, WA 98550-3615
Phone (360) 533-7395

Other identifiers 4

IdentifierTypeStateIssuer
1404OtherWASTATE LISCENSE
2064905MedicaidWA
DD0837OtherWAPALMETTO - RR MEDICARE
T02623OtherWAUPIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050516000990 WA Part B Supplier - Clinic/Group Practice 2264472604 Receives reassigned benefits from 4 practitioners
Practice locations: Hoquiam, WA; Ocean Shores, WA; Westport, WA

National Provider Directory

National Provider Directory

Locations

403 7th St
Hoquiam, WA 98550
Phone (360) 532-0060

413 8th St
Hoquiam, WA 98550
Phone (360) 533-7395

848 Ocean Shores Blvd NW
Ocean Shores, WA 98569
Phone (360) 289-0603

723 N Montesano St
Westport, WA 98595
Phone (360) 268-0195

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1164611133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 7TH ST",
            "city": "HOQUIAM",
            "state": "WA",
            "postal_code": "985503615",
            "telephone_number": "360-533-7395",
            "fax_number": "360-532-6907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 7TH ST",
            "city": "HOQUIAM",
            "state": "WA",
            "postal_code": "985503615",
            "telephone_number": "360-533-7395",
            "fax_number": "360-532-6907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOQUIAM VISION CLINIC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-16",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "WAYMAN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "360-533-7395",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00001404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LISCENSE",
            "identifier": "1404",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2064905",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO - RR MEDICARE",
            "identifier": "DD0837",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "T02623",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hoquiam, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; 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.