Bradley Alan Frederickson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD00003074 Issued in WA

Practice address

34719 6TH Ave S
Federal Way, WA 98003-8714

Phone

(206) 212-2100

Fax

(206) 212-2194

NPI assigned

Aug 25, 2006

Last updated

Jan 3, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 15

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

Pacific University - College of Optometry, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Evergreen Eye Center PLLCGroup PAC ID 3173410057, shared by 5 NPIs, 33 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

96.39 of 100Reported as individual

Quality

92.77

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bfrederickson@cepwa-eec.emadirect.md

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

• Evergreen Eye Center, PLLC

  dba Evergreen Eye Center

  • Ophthalmology Physician
  • Federal Way, WA
  • NPI 1700959293

  Optometrist

  Medicare reassignment NPD
• Evergreen Eye Center, PLLC

  dba Evergreen Eye Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Federal Way, WA
  • NPI 1821167479
  Medicare reassignment NPD
• Evergreen Eye Center, PLLC

  dba Eye Associates Northwest Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Seattle, WA
  • NPI 1184689408
  NPD
• Evergreen Eye Center, PLLC

  • Ophthalmology Physician
  • Auburn, WA
  • NPI 1346319852

  Optometrist

  NPD
• Evergreen Eye Center, PLLC

  dba Evergreen Eye Center

  • Ophthalmology Physician
  • Burien, WA
  • NPI 1538238043

  Optometrist

  NPD
• Evergreen Eye Center, PLLC

  dba Eye Associates Northwest, PLLC

  • Ophthalmology Physician
  • Seattle, WA
  • NPI 1275387995
  NPD (past)

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704240000000",
    "number": "1174631899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34719 6TH AVE S",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038714",
            "telephone_number": "206-212-2100",
            "fax_number": "206-212-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34719 6TH AVE S",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038714",
            "telephone_number": "206-212-2100",
            "fax_number": "206-212-2194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKSON",
        "first_name": "BRADLEY",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00003074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2017259",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I GROUP NUMBER",
            "identifier": "59460",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE & WPS BURIEN #",
            "identifier": "91162803298116A005",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE FEDERAL WAY RYDER",
            "identifier": "FR8712",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I INDIVIDUAL NUMBER",
            "identifier": "59461",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIMS GROUP NUMBE",
            "identifier": "891451",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE AUBURN RYDER #",
            "identifier": "FR5328",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2017242",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BURIEN RYDER #",
            "identifier": "2187FR",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BILLING ID #",
            "identifier": "911628032",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA GROUP PROVIDER NUMB",
            "identifier": "0870427",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE NUMBER",
            "identifier": "410028421",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE & WPS AUBURN #",
            "identifier": "91162803298002A003",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE & WPS FEDERAL WAY",
            "identifier": "91162803298003A003",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE GROUP EEC #",
            "identifier": "EV8144",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Federal Way, WA
• Providers in Federal Way, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; 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.