Active NPI
Edwin G Ambo
- Optometrist
- Issaquah, WA
National Provider Identifier
1336277102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1804T
- Practice address
- 1801 10TH Ave NW
Issaquah, WA 98027-5384 - Phone
- (425) 369-6726
- NPI assigned
- Mar 1, 2007
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1804T | WA | Primary |
Addresses
Primary practice location
1801 10TH Ave NW
Issaquah, WA 98027-5384
Mailing address
1801 10TH Ave NW
Issaquah, WA 98027-5384
Phone (425) 369-6726
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 27, 2021 through Jan 27, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1804T | WA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336277102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1801 10TH AVE NW",
"city": "ISSAQUAH",
"state": "WA",
"postal_code": "980275384",
"telephone_number": "425-369-6726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 10TH AVE NW",
"city": "ISSAQUAH",
"state": "WA",
"postal_code": "980275384",
"telephone_number": "425-369-6726"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AMBO",
"first_name": "EDWIN",
"middle_name": "G",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "1804T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Issaquah, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.