Pearl Optical Inc P S

Primary specialty

OptometristTaxonomy code 152W00000X

License

1426TX Issued in WA

Legal business name

PEARL OPTICAL INC P S

Practice address

407 Baker Blvd
Tukwila, WA 98188-2906

Phone

(206) 246-5430

Fax

(206) 246-7826

NPI assigned

Oct 18, 2007

Organization subpart

No

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

Authorized official

Name

Michael D Noble, OD

Title

President

Phone

(206) 246-5430

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633651200000",
    "number": "1205025962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 BAKER BLVD",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882906",
            "telephone_number": "206-246-5430",
            "fax_number": "206-246-7826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 BAKER BLVD",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882906",
            "telephone_number": "206-246-5430",
            "fax_number": "206-246-7826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEARL OPTICAL INC P S",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-18",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A",
        "authorized_official_last_name": "NOBLE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "206-246-5430",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "1426TX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OLD PIN",
            "identifier": "G217112300",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; 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.