Individual provider Active NPI

Mallory Troyer, OD

  • Optometrist
  • North Bend, WA
National Provider Identifier
1326664921
Registry record updated Mar 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2194 Issued in SC
Practice address
126 E 2ND St
North Bend, WA 98045-9175
Phone
(425) 831-2020
NPI assigned
Jun 19, 2020
Last updated
Mar 6, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2194 SC Primary

Addresses

Primary practice location

126 E 2ND St
North Bend, WA 98045-9175

Mailing address

126 E 2ND St
North Bend, WA 98045-9175

Other identifiers 1

IdentifierTypeStateIssuer
2193427MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211013002984 WA Practitioner - Optometry 8325446883 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eyecare Partners PLLCGroup PAC ID 7911120084, 5 clinicians

Practice addresses (Care Compare)

126 E 2ND St
North Bend, WA 98045-9175
Phone (425) 831-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2194SCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Eyecare Partners, PLLC Multi-Specialty CurrentSince Oct 7, 2021 Accepting new patients
Eyecare Partners, PLLC Multi-Specialty CurrentSince Oct 7, 2021 Accepting new patients
Eyecare Partners, PLLC Multi-Specialty Past Accepting new patients

Locations

126 E 2nd St
North Bend, WA 98045
Phone (425) 831-2020

22620 SE 4th St
Ste 110
Sammamish, WA 98074
Phone (425) 242-6868

7726 Center Blvd SE
Snoqualmie, WA 98065

7726 Center Blvd SE
Ste 100
Snoqualmie, WA 98065
Phone (425) 831-2020

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678060800000",
    "number": "1326664921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 E 2ND ST",
            "city": "NORTH BEND",
            "state": "WA",
            "postal_code": "980459175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 E 2ND ST",
            "city": "NORTH BEND",
            "state": "WA",
            "postal_code": "980459175",
            "telephone_number": "425-831-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TROYER",
        "first_name": "MALLORY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-19",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "2194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2193427",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Bend, WA

Sources for this page

Verify at the official NPI Registry.