Active NPI
Jeffry Alan Green, OD
- Optometrist
- Everett, WA
National Provider Identifier
1386735264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- WA1713TX
- Practice address
- 2522 Colby Ave
Everett, WA 98201 - Phone
- (425) 252-1231
- Fax
- (425) 257-9881
- NPI assigned
- Sep 27, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 | WA1713TX | WA | Primary |
Addresses
Primary practice location
2522 Colby Ave
Everett, WA 98201
Mailing address
2522 Colby Ave
Everett, WA 98201
Phone (425) 252-1231
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 |
|---|---|---|---|
| WA1713TX | WA | MD | Optometrist |
| 1713 | TX | MD | Electroneurodiagnostic Specialist/Technologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DRS Green and Sundholm ENT Inc PS | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386735264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2522 COLBY AVE",
"city": "EVERETT",
"state": "WA",
"postal_code": "98201",
"telephone_number": "425-252-1231",
"fax_number": "425-257-9881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2522 COLBY AVE",
"city": "EVERETT",
"state": "WA",
"postal_code": "98201",
"telephone_number": "425-252-1231",
"fax_number": "425-257-9881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "JEFFRY",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "WA1713TX",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Everett, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.