NPIMap

Organization Active NPI

Specialty Eyecare Group Inc

Doing business as Totem Lake Vision Center

  • Optometrist
  • Kirkland, WA
National Provider Identifier
1235317637
Registry record updated Feb 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD00004018 Issued in WA
Legal business name
SPECIALTY EYECARE GROUP INC
Doing business as
Totem Lake Vision Center
Practice address
11830 NE 128TH St Ste 1
Kirkland, WA 98034-7202
Phone
(425) 821-8900
Fax
(425) 814-9782
NPI assigned
Feb 7, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2008

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

Authorized official

Name
Dr. David L Kading, ODNPI 1013029719
Title
President
Phone
(425) 821-8900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OD00004018 WA Primary

Addresses

Primary practice location

11830 NE 128TH St Ste 1
Kirkland, WA 98034-7202

Mailing address

11830 NE 128TH St Ste 1
Kirkland, WA 98034-7202
Phone (425) 821-8900

Other names 1

  • Totem Lake Vision Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080221000625 WA Part B Supplier - Clinic/Group Practice 8325122823 Receives reassigned benefits from 13 practitioners
Practice locations: Bellevue, WA; Kirkland, WA; Seattle, WA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2029238Specialty Eyecare Group11830 NE 128TH St Ste 1, Kirkland, WA 98034Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

225 106th Ave NE
Bellevue, WA 98004
Phone (425) 454-2028

11830 NE 128th St
Ste 1
Kirkland, WA 98034
Phone (425) 814-8900

1911 4th Ave
Seattle, WA 98101
Phone (206) 622-4828

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202342400000",
    "number": "1235317637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11830 NE 128TH ST STE 1",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980347202",
            "telephone_number": "425-821-8900",
            "fax_number": "425-814-9782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11830 NE 128TH ST STE 1",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980347202",
            "telephone_number": "425-821-8900",
            "fax_number": "425-814-9782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY EYECARE GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-07",
        "last_updated": "2008-02-07",
        "status": "A",
        "authorized_official_last_name": "KADING",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "425-821-8900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00004018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Totem Lake Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.