NPIMap

Organization Active NPI

Evergreen Eye Center, PLLC

Doing business as Evergreen Eye Center

  • Ophthalmology Physician
  • Tacoma, WA
National Provider Identifier
1407401920
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
EVERGREEN EYE CENTER, PLLC
Doing business as
Evergreen Eye Center
Practice address
502 S M St
Tacoma, WA 98405-3728
Phone
(800) 340-3595
NPI assigned
Aug 2, 2019
Last updated
Jan 12, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
EVERGREEN EYE CENTER, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Authorized official

Name
Rosa Campos
Title
Credentialing Manager
Phone
(206) 215-2004

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary
Ambulatory Surgical Clinic/Center 261QA1903X

Addresses

Primary practice location

502 S M St
Tacoma, WA 98405-3728

Mailing address

502 S M St
Tacoma, WA 98405-3728

Other names 1

  • Evergreen Eye Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040304001193 WA Part B Supplier - Clinic/Group Practice 3173410057 Receives reassigned benefits from 40 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Seattle, WA; Tacoma, WA; Federal Way, WA; Kirkland, WA; Auburn, WA; Edmonds, WA; Burien, WA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Eye Center PLLC11 organizations share this tax ID, including this one
Part of
Evergreen Eye Center PLLC

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1564704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1407401920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 S M ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984053728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 S M ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984053728",
            "telephone_number": "800-340-3595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN EYE CENTER, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERGREEN EYE CENTER, PLLC",
        "enumeration_date": "2019-08-02",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A",
        "authorized_official_last_name": "CAMPOS",
        "authorized_official_first_name": "ROSA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "206-215-2004"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Eye Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Evergreen Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.