Alderwood Vision Clinic, Inc. P.S.

Primary specialty

OptometristTaxonomy code 152W00000X

License

600387275 Issued in WA

Legal business name

ALDERWOOD VISION CLINIC, INC. P.S.

Practice address

18631 Alderwood Mall Pkwy Ste 105
Lynnwood, WA 98037-8057

Phone

(425) 771-2662

Fax

(425) 670-2333

NPI assigned

Oct 25, 2006

Organization subpart

No

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

Authorized official

Name

Ivan Derek Hyde, O.D.

Title

President

Phone

(425) 771-2662

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1396829123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18631 ALDERWOOD MALL PKWY STE 105",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980378057",
            "telephone_number": "425-771-2662",
            "fax_number": "425-670-2333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18631 ALDERWOOD MALL PKWY STE 105",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980378057",
            "telephone_number": "425-771-2662",
            "fax_number": "425-670-2333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALDERWOOD VISION CLINIC, INC. P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "HYDE",
        "authorized_official_first_name": "IVAN",
        "authorized_official_middle_name": "DEREK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "425-771-2662",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "600387275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2001873",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alderwood Optometric Services PLLC
• Alderwood Psychological Services, Inc.
• Alderwood Superior Healthcare PLLC
• Alderwood Surgery Center LLC (Allure Esthetic)
• Alderwood Surgery Center LLC
• Alderwood Vision Therapy and Development PLLC (Alderwood Vision Therapy and Development)
• David Alan Alexander, MD
• Kelsey Rae Alfonso
• Danya Alghanmi
• Dalia Ali

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; 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.