Metasha Pak Carson, DO 61511845

Primary specialty

OpticianTaxonomy code 156FX1800X

License

DO61511845 Issued in WA

Practice address

21200 Olhava Way NW
Poulsbo, WA 98370-9457

Phone

(360) 697-2513

Fax

(360) 697-2664

NPI assigned

Jun 13, 2024

Last updated

Jun 13, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1718236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1205679610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21200 OLHAVA WAY NW",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983709457",
            "telephone_number": "360-697-2513",
            "fax_number": "360-697-2664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21200 OLHAVA WAY NW",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983709457",
            "telephone_number": "360-697-2513",
            "fax_number": "360-697-2664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARSON",
        "first_name": "METASHA",
        "middle_name": "PAK",
        "credential": "DO 61511845",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-13",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "WA",
            "license": "DO61511845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optician in Poulsbo, WA
• Providers in Poulsbo, WA by specialty
• Optician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.