Jerianne Montgomery, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

60314137 Issued in WA

Practice address

26615 Maple Valley Black Diamond Rd SE
Maple Valley, WA 98038-8347

Phone

(425) 413-8787

NPI assigned

Jan 15, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Optometry

Education

University of Waterloo - School of Optometry, 2003

Medicare assignment

May accept Medicare assignment

Group practices

Maple Valley Eye Care Center PSGroup PAC ID 0446249411, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Maple Valley Eye Care Center PS

  • Optometrist
  • Maple Valley, WA
  • NPI 1124224217
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1389744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453420800000",
    "number": "1164844734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21806 240TH PL SE",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980388463",
            "telephone_number": "253-737-8336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26615 MAPLE VALLEY BLACK DIAMOND RD SE",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980388347",
            "telephone_number": "425-413-8787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "JERIANNE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-01-15",
        "last_updated": "2016-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "60314137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derek Middlekauff
• Madeline Elizabeth Miller
• David Minoru Miyatake, DDS
• Nura Abdi Mohamed
• Kara Moniz
• Ashley R Montoya-Holden, RBT
• L. Carlos Morales, DDS, PS
• Brandon Morris, OD
• Marianna Moudy, M.S. CCC-SLP
• Marti Bunker Mueller, REGISTERED NURSE

• Optometrist in Maple Valley, WA
• Providers in Maple Valley, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.