Active NPI
Carl R. Marcus, O.D.
- Optometrist
- Auburn, WA
National Provider Identifier
1366656894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OD00000853
- Practice address
- 36216 57TH Ave S
Auburn, WA 98001-9307 - Phone
- (253) 735-6548
- Fax
- (253) 735-6548
- NPI assigned
- May 10, 2007
- Last updated
- Jan 4, 2011
- 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 | OD00000853 | WA | Primary |
Addresses
Primary practice location
36216 57TH Ave S
Auburn, WA 98001-9307
Mailing address
PO Box 232
Milton, WA 98354-0232
Phone (253) 735-6548
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 911348 | Other | WA | EYEMED |
| MA0876 | Other | WA | REGENCE BLUE SHIELD |
| 93422275060001 | Other | WA | PREMERA BLUE CROSS NATACT |
| 2567402 | Medicaid | WA | |
| WA0514 | Other | WA | NORTHWEST BENEFIT NETWORK |
| 227506100000 | Other | WA | PREMERA BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OD00000853 | WA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294099200000",
"number": "1366656894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 232",
"city": "MILTON",
"state": "WA",
"postal_code": "983540232",
"telephone_number": "253-735-6548",
"fax_number": "253-735-6548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36216 57TH AVE S",
"city": "AUBURN",
"state": "WA",
"postal_code": "980019307",
"telephone_number": "253-735-6548",
"fax_number": "253-735-6548"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARCUS",
"first_name": "CARL",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-10",
"last_updated": "2011-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "OD00000853",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYEMED",
"identifier": "911348",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "MA0876",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREMERA BLUE CROSS NATACT",
"identifier": "93422275060001",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2567402",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NORTHWEST BENEFIT NETWORK",
"identifier": "WA0514",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREMERA BLUE CROSS",
"identifier": "227506100000",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Auburn, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.