NPIMap

Organization Active NPI

Proliance Surgeons, Inc., P.S.

  • Ophthalmology Physician
  • Redmond, WA
National Provider Identifier
1265986376
Registry record updated Aug 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
601484763 Issued in WA
Legal business name
PROLIANCE SURGEONS, INC., P.S.
Practice address
17130 Avondale Way NE Ste 111
Redmond, WA 98052-4455
Phone
(425) 885-6600
Fax
(425) 885-6580
NPI assigned
Aug 5, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2022

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

Authorized official

Name
Cori M. Pleasant
Title
MGR Provider Relations/Enrollment
Phone
(206) 838-2585

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 601484763 WA
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 601484763 WA Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

17130 Avondale Way NE Ste 111
Redmond, WA 98052-4455

Mailing address

17130 Avondale Way NE Ste 111
Redmond, WA 98052-4455
Phone (425) 885-6600

Other practice location 1

1321 Aaron Dr
Richland, WA 99352-4678
Phone (425) 885-6600

Other identifiers 2

IdentifierTypeStateIssuer
222338OtherWAWA STATE L & I
2001403MedicaidWA

Other names 1

  • Proliance The Children and Family Eye Doctors Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031119000128 WA Part B Supplier - Clinic/Group Practice 8527972900 Receives reassigned benefits from 781 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Orthopedic Physicians46 organizations share this tax ID, including this one

Other organizations with this tax ID 45

Organizations that report the same tax identification number in the National Provider Directory.

View all 45

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1470355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661126400000",
    "number": "1265986376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17130 AVONDALE WAY NE STE 111",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "980524455",
            "telephone_number": "425-885-6600",
            "fax_number": "425-885-6580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17130 AVONDALE WAY NE STE 111",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "980524455",
            "telephone_number": "425-885-6600",
            "fax_number": "425-885-6580"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1321 Aaron Dr",
            "address_purpose": "LOCATION",
            "city": "Richland",
            "state": "WA",
            "postal_code": "993524678",
            "country_code": "US",
            "telephone_number": "425-885-6600",
            "fax_number": "425-885-6580",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-05",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A",
        "authorized_official_last_name": "PLEASANT",
        "authorized_official_first_name": "CORI",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MGR PROVIDER RELATIONS/ENROLLMENT",
        "authorized_official_telephone_number": "206-838-2585"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "601484763",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "WA",
            "license": "601484763",
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA STATE L & I",
            "identifier": "222338",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2001403",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proliance The Children and Family Eye Doctors",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Redmond, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.