NPIMap

Organization Active NPI

Evergreen Eye Center, PLLC

Doing business as Eye Associates Northwest, PLLC

  • Ophthalmology Physician
  • Seattle, WA
National Provider Identifier
1275387995
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
EVERGREEN EYE CENTER, PLLC
Doing business as
Eye Associates Northwest, PLLC
Practice address
1101 Madison St Ste 600
Seattle, WA 98104-1340
Phone
(206) 215-2020
Fax
(206) 215-2022
NPI assigned
Apr 17, 2024
Last updated
Apr 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

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

Authorized official

Name
John J Whitehead, MDNPI 1891866679
Title
Authorized Official
Phone
(206) 215-2004

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
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

1101 Madison St Ste 600
Seattle, WA 98104-1340

Mailing address

33600 6TH Ave S
Federal Way, WA 98003-6743
Phone (206) 260-2503

Other practice location 1

1455 NW Leary Way Ste 300
Seattle, WA 98107-5138
Phone (206) 784-3550

Other practice location 2

11325 NE 120th St
Kirkland, WA 98034-6907
Phone (425) 821-6655

Other practice location 3

21616 76th Ave W Ste 110
Edmonds, WA 98026-7512
Phone (425) 775-0548

Other practice location 4

155 NE 100th St Ste 110
Seattle, WA 98125-8007
Phone (206) 363-8855

Other names 1

  • EYE ASSOCIATES NORTHWEST, PLLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040304001193 WA Part B Supplier - Clinic/Group Practice 3173410057 Receives reassigned benefits from 40 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Seattle, WA; Tacoma, WA; Federal Way, WA; Kirkland, WA; Auburn, WA; Edmonds, WA; Burien, WA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Eye Center PLLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

33600 6th Ave S
Federal Way, WA 98003

Practitioners & affiliated clinicians

Practitioners 37

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.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1713312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1275387995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33600 6TH AVE S",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980036743",
            "telephone_number": "206-260-2503",
            "fax_number": "855-929-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 MADISON ST STE 600",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041340",
            "telephone_number": "206-215-2020",
            "fax_number": "206-215-2022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1455 NW Leary Way Ste 300",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981075138",
            "country_code": "US",
            "telephone_number": "206-784-3550",
            "fax_number": "206-781-8693",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11325 NE 120th St",
            "address_purpose": "LOCATION",
            "city": "Kirkland",
            "state": "WA",
            "postal_code": "980346907",
            "country_code": "US",
            "telephone_number": "425-821-6655",
            "fax_number": "425-821-8836",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "21616 76th Ave W Ste 110",
            "address_purpose": "LOCATION",
            "city": "Edmonds",
            "state": "WA",
            "postal_code": "980267512",
            "country_code": "US",
            "telephone_number": "425-775-0548",
            "fax_number": "425-670-6708",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "155 NE 100th St Ste 110",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981258007",
            "country_code": "US",
            "telephone_number": "206-363-8855",
            "fax_number": "206-367-9066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVERGREEN EYE CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-17",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "WHITEHEAD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "206-215-2004",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EYE ASSOCIATES NORTHWEST, PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; 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.