Eyejoa Optical, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4020TX Issued in WA

Legal business name

EYEJOA OPTICAL, LLC

Doing business as

Eyejoa Optical

Practice address

8705 S Tacoma Way
Lakewood, WA 98499-4544

Phone

(253) 582-3698

NPI assigned

Feb 22, 2007

Organization subpart

No

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

Authorized official

Name

Mr. John T. Bae

Title

General Partner

Phone

(253) 582-3698

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Eyejoa Optical Doing business as

Locations

Practitioners 1

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

• Tara S. Waterbury

  • Optometrist
  • Lakewood, WA
  • NPI 1215062021
  NPD (past)

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194850925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8705 S TACOMA WAY",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984994544",
            "telephone_number": "253-582-3698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8705 S TACOMA WAY",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984994544",
            "telephone_number": "253-582-3698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYEJOA OPTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "GENERAL PARTNER",
        "authorized_official_telephone_number": "253-582-3698",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "4020TX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE PROVIDER ID",
            "identifier": "8705WA",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2031326",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyejoa Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Fayanna Evans
• Hilary Evans
• Jalen Rose Evans
• Joseph Mark Evans, M.D.
• William Cody Ewing, CPHT
• Corbin Charles Eylander, DDS
• Robert T. Fabi, DMD
• Erin Ruby Fackler
• Lauren Lesley Tulia Failauga
• Paul Faillace, RN

• Optometrist in Lakewood, WA
• Providers in Lakewood, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.