Active NPI
Jerry Quon Tom, O.D.
- Corneal and Contact Management Optometrist
- Seattle, WA
National Provider Identifier
1386753929
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Corneal and Contact Management Optometrist
- License
- WA 1895
- Practice address
- 4323 University Way NE
Seattle, WA 98105-5808 - Phone
- (206) 633-1081
- Fax
- (206) 633-1432
- NPI assigned
- Aug 29, 2006
- 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 |
|---|---|---|---|---|
| Corneal and Contact Management Optometrist | 152WC0802X | WA 1895 | WA | Primary |
Addresses
Primary practice location
4323 University Way NE
Seattle, WA 98105-5808
Mailing address
4323 University Way NE
Seattle, WA 98105-5808
Phone (206) 633-1081
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 7, 2024 through Jun 7, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| WA 1895 | WA | MD | Corneal and Contact Management Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386753929",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4323 UNIVERSITY WAY NE",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981055808",
"telephone_number": "206-633-1081",
"fax_number": "206-633-1432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4323 UNIVERSITY WAY NE",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981055808",
"telephone_number": "206-633-1081",
"fax_number": "206-633-1432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TOM",
"first_name": "JERRY",
"middle_name": "QUON",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "WA",
"license": "WA 1895",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.