Angelica Rose Sup, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD00003975 Issued in WA

Practice address

21911 76TH Ave W
Suite 101
Edmonds, WA 98026-7903

Phone

(425) 774-7723

Fax

(425) 778-2788

NPI assigned

Oct 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Samuel K. Seto MD PLLC

  • Specialist
  • Edmonds, WA
  • NPI 1497827711
  NPD (past)

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1366522633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21911 76TH AVE W",
            "address_2": "SUITE 101",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267903",
            "telephone_number": "425-774-7723",
            "fax_number": "425-778-2788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21911 76TH AVE W",
            "address_2": "SUITE 101",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267903",
            "telephone_number": "425-774-7723",
            "fax_number": "425-778-2788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUP",
        "first_name": "ANGELICA",
        "middle_name": "ROSE",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00003975",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I PROVIDER NUMBER",
            "identifier": "0202735",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE PROVIDER NUMBER",
            "identifier": "2161SU",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffery D Stuart, P.T.
• Meghan E Sueltenfuss, MSPT
• Tamara Suzann Sullivan, RN
• Sumnicht Eye Care
• Andrew John Sumnicht, MD
• Sustainability Management Company LLC
• Sucheta Suthar
• Tara A Sutherland, DO
• Ajhanae Sutton-Richardson
• Britney Lee Sutton

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.

Verify at the official NPI Registry.