Individual provider Active NPI

Frederick Satkowiak, OD

  • Optometrist
  • Tacoma, WA
National Provider Identifier
1235103789
Registry record updated Mar 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
60385557 Issued in WA
Practice address
9040 Jackson Ave
Tacoma, WA 98431-8568
Phone
(253) 968-2798
NPI assigned
Feb 13, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 2, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 60385557 WA Primary
Optometrist 152W00000X OEG1990 PA

Addresses

Primary practice location

9040 Jackson Ave
Tacoma, WA 98431-8568

Mailing address

10916 65TH Ave NW
Gig Harbor, WA 98332-8568
Phone (253) 852-8787

Other practice location 1

10916 65th Ave NW
Gig Harbor, WA 98332-8568
Phone (253) 852-8787

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20130731000852 WA Order and Referring Only - OptometryPractitioner - Optometry 6901047034

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OEG1990PAMDOptometrist
60385557WAMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551484800000",
    "number": "1235103789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10916 65TH AVE NW",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983328568",
            "telephone_number": "253-852-8787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984318568",
            "telephone_number": "253-968-2798"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10916 65th Ave NW",
            "address_purpose": "LOCATION",
            "city": "Gig Harbor",
            "state": "WA",
            "postal_code": "983328568",
            "country_code": "US",
            "telephone_number": "253-852-8787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SATKOWIAK",
        "first_name": "FREDERICK",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2019-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "60385557",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG1990",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.