Blue Mountain Eye PLLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

BLUE MOUNTAIN EYE PLLC

Doing business as

Lifestyle Eye Center

Practice address

1610 Penny LN
Walla Walla, WA 99362-4477

Phone

(509) 540-3937

Fax

(509) 540-3938

NPI assigned

Oct 27, 2010

Last updated

Jan 22, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Benjamin M Higginbotham

Title

Practice Administrator

Phone

(509) 540-3937

Specialties & licenses 5

Addresses

Other names 1

• Lifestyle Eye Center Doing business as

Medicare fee-for-service enrollment

Enrolled in WA, OR2 enrollments

Enrollment records 2

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

CLIA laboratory certificates

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michelle M Monkman, O.D.

  • Optometrist
  • Pendleton, OR
  • NPI 1497801708

  WA

  Medicare reassignment Care Compare group NPD
• Tara Elizabeth Evanger-Dalke, O.D.

  • Optometrist
  • Walla Walla, WA
  • NPI 1316222466

  OR

  Medicare reassignment Care Compare group
• Arthur W Giebel, MD

  • Ophthalmology Physician
  • Walla Walla, WA
  • NPI 1083665954

  OR

  Medicare reassignment Care Compare group
• Jonathan D Haley, OD

  • Optometrist
  • Walla Walla, WA
  • NPI 1871919167

  OR

  Medicare reassignment NPD
• Christina Nguyen, OD

  • Optometrist
  • Salem, OR
  • NPI 1679003313

  WA

  Medicare reassignment NPD
• Hanna F Shammas, M.D.

  • Ophthalmology Physician
  • Lynwood, CA
  • NPI 1770698854
  NPD

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

{
    "created_epoch": "1288137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548115200000",
    "number": "1255631016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX O",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993620212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 PENNY LN",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624477",
            "telephone_number": "509-540-3937",
            "fax_number": "509-540-3938"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1070 W Elm Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Hermiston",
            "state": "OR",
            "postal_code": "978382711",
            "country_code": "US",
            "telephone_number": "541-656-2211",
            "fax_number": "541-656-2233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLUE MOUNTAIN EYE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-27",
        "last_updated": "2019-01-22",
        "status": "A",
        "authorized_official_last_name": "HIGGINBOTHAM",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "509-540-3937",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0120X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Cornea and External Diseases Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0009X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Glaucoma Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0108X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Uveitis and Ocular Inflammatory Disease",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifestyle Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeral Lee Ann Blankenship
• Sarah R. Blattler, LMP
• Karen Blood
• Roger K Blood
• Blue Mountain Action Council
• Blue Mountain Genetics Clinic, PLLC
• Blue Mountain Health Cooperative
• Blue Mountain Heart to Heart
• Blue Mountain Industries LLC (Blue Mountain Industries)
• Blue Mountain Medical Goup, PLLC

• Ophthalmology Physician in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Ophthalmology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; 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.