Active NPI
Eddie P Kwan, OD
- Optometrist
- Lynnwood, WA
National Provider Identifier
1306949946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1165
- Practice address
- 1400 164TH SW
Lynnwood, WA 98037 - Phone
- (425) 741-8937
- NPI assigned
- Sep 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1165 | WA | Primary |
| Optometrist | 152W00000X | 1319 | OR | |
| Optometrist | 152W00000X | 1678 | MN |
Addresses
Primary practice location
1400 164TH SW
Lynnwood, WA 98037
Mailing address
23614 107TH PL W
Edmonds, WA 98020
Phone (206) 542-0962
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1678 | MN | MD | Clinical Social Worker |
| 1319 | OR | MD | Optometrist |
| 1165 | WA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1306949946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23614 107TH PL W",
"city": "EDMONDS",
"state": "WA",
"postal_code": "98020",
"telephone_number": "206-542-0962"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 164TH SW",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "98037",
"telephone_number": "425-741-8937"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWAN",
"first_name": "EDDIE",
"middle_name": "P",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "1165",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OR",
"license": "1319",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "1678",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.