Dr. J. Song, Optometrist, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD00004160 Issued in WA

Legal business name

DR. J. SONG, OPTOMETRIST, INC.

Doing business as

Lake Hills Eye Clinic

Practice address

17 148TH Ave SE
Ste a
Bellevue, WA 98007-5164

Phone

(425) 644-6478

Fax

(425) 644-6476

NPI assigned

Nov 22, 2007

Last updated

Sep 4, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jeong-Hun Song, O.D.

Title

President & Ceo

Phone

(425) 644-6478

Specialties & licenses 1

Addresses

Other names 1

• Lake Hills Eye Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Richard Song, OD

  • Optometrist
  • Bellevue, WA
  • NPI 1811072028
  Medicare reassignment

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

{
    "created_epoch": "1195689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536019200000",
    "number": "1336320068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 394",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980090394",
            "telephone_number": "425-644-6478",
            "fax_number": "425-644-6476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 148TH AVE SE",
            "address_2": "STE A",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980075164",
            "telephone_number": "425-644-6478",
            "fax_number": "425-644-6476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. J. SONG, OPTOMETRIST, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-22",
        "last_updated": "2018-09-04",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "JEONG-HUN",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "425-644-6478",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00004160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Hills Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Hills Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.