Charles Srisatayasunton, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3641ATI Issued in OR

Practice address

19400 108TH Ave SE Ste 202
Kent, WA 98031-0108

Phone

(253) 852-2120

NPI assigned

Oct 10, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Clear Sight Northwest, PS

  dba Benson Eye Clinic

  • Optometrist
  • Kent, WA
  • NPI 1740558642
  NPD

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

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1265784508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19400 108TH AVE SE STE 202",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980310108",
            "telephone_number": "253-852-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19400 108TH AVE SE STE 202",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980310108",
            "telephone_number": "253-852-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SRISATAYASUNTON",
        "first_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-10",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60658151",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3641ATI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elaine Sperry, LPN
• Spine Factor Chiropractic & Wellness, PLLC (Romney Chiropractic)
• Taylor Kristine Spooner, SLP
• Grace Victoria Sprague
• Sadie Jean Spurr
• Kellie Srock, OTR/L
• Suze St Louis, LMP
• Rachael Lynn St. Clair, LMHC
• John Andrew St. Laurent Sr., L.M.P
• Judith E. Stacey-Robar, ARNP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.