Milton-Edgewood Eye Clinic, PLLC
Organization Active NPI Optometrist · Milton, WA
NPI 1295973345 · NPPES record last updated Jan 28, 2009
Key facts
- NPI
- 1295973345
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- OD00003106 (WA)
- Legal business name
- MILTON-EDGEWOOD EYE CLINIC, PLLC
- Practice address
- 900 Meridian E Ste 18
Milton, WA 98354-7003 - Phone
- (253) 927-5252
- Fax
- (253) 927-4270
- NPI assigned
- Jan 28, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Teresa A Erickson, O.D.
- Title
- Managing Member
- Phone
- (253) 927-5252
Practitioners 4
-
Kelly K Malueg, OD
-
Laura A. Toepfer, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090402000591 | WA | Part B Supplier - Clinic/Group Practice | 6608923958 |
Receives reassigned benefits from 2 practitioners Practice locations: Milton, WA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | OD00003106 | WA | Yes |
Addresses
Primary practice location
900 Meridian E Ste 18
Milton, WA 98354-7003
Mailing address
900 Meridian E Ste 18
Milton, WA 98354-7003
Phone (253) 927-5252
NPI Registry JSON
{
"created_epoch": "1233100800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1233100800000",
"number": "1295973345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 MERIDIAN E STE 18",
"city": "MILTON",
"state": "WA",
"postal_code": "983547003",
"telephone_number": "253-927-5252",
"fax_number": "253-927-4270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 MERIDIAN E STE 18",
"city": "MILTON",
"state": "WA",
"postal_code": "983547003",
"telephone_number": "253-927-5252",
"fax_number": "253-927-4270"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MILTON-EDGEWOOD EYE CLINIC, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-01-28",
"last_updated": "2009-01-28",
"status": "A",
"authorized_official_last_name": "ERICKSON",
"authorized_official_first_name": "TERESA",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "MANAGING MEMBER",
"authorized_official_telephone_number": "253-927-5252",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "WA",
"license": "OD00003106",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.