Active NPI
C. Sanford Berry, O.D.
- Corneal and Contact Management Optometrist
- Tumwater, WA
National Provider Identifier
1316057201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Corneal and Contact Management Optometrist
- License
- OD00001759
- Practice address
- 5500 Littlerock Rd SW
Costco Optical
Tumwater, WA 98512-7363 - Phone
- (360) 709-0878
- Fax
- (360) 709-0878
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Corneal and Contact Management Optometrist | 152WC0802X | OD00001759 | WA | Primary |
Addresses
Primary practice location
5500 Littlerock Rd SW
Costco Optical
Tumwater, WA 98512-7363
Mailing address
PO Box 2941
Olympia, WA 98507-2941
Phone (360) 402-0019
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 |
|---|---|---|---|
| OD00001759 | WA | MD | Corneal and Contact Management Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316057201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2941",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985072941",
"telephone_number": "360-402-0019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5500 LITTLEROCK RD SW",
"address_2": "COSTCO OPTICAL",
"city": "TUMWATER",
"state": "WA",
"postal_code": "985127363",
"telephone_number": "360-709-0878",
"fax_number": "360-709-0878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERRY",
"first_name": "C.",
"middle_name": "SANFORD",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "WA",
"license": "OD00001759",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tumwater, 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.