Active NPI
Kristin Liffick Jacob, O.D.
- Optometrist
- Bellevue, WA
National Provider Identifier
1356436547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 00003683
- Practice address
- 15600 NE 8TH Suite Q2
C/O Paris Miki Optical
Bellevue, WA 98008 - Phone
- (425) 641-7482
- Fax
- (425) 641-5802
- NPI assigned
- Oct 4, 2006
- Sex
- Female
- 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 | 00003683 | WA | Primary |
Addresses
Primary practice location
15600 NE 8TH Suite Q2
C/O Paris Miki Optical
Bellevue, WA 98008
Mailing address
15600 NE 8TH St Ste Q2
Bellevue, WA 98008-3956
Phone (425) 641-7482
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050818000719 | WA | Practitioner - Optometry | 5092745034 | Practice locations: Bellevue, WA |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
15522 Lake Hills Blvd
Bellevue, WA 98007-5928
Phone (425) 590-9303
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00003683 | WA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187827200000",
"number": "1356436547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15600 NE 8TH ST STE Q2",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980083956",
"telephone_number": "425-641-7482",
"fax_number": "425-641-5802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15600 NE 8TH SUITE Q2",
"address_2": "C/O PARIS MIKI OPTICAL",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "98008",
"telephone_number": "425-641-7482",
"fax_number": "425-641-5802"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "KRISTIN",
"middle_name": "LIFFICK",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2007-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "00003683",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellevue, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.