NPIMap

Organization Active NPI

Evergreen Vision Corp.

  • Optometrist
  • Seattle, WA
National Provider Identifier
1407885197
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2089 Issued in WA
Legal business name
EVERGREEN VISION CORP.
Practice address
412 12TH Ave S
#205
Seattle, WA 98144-2032
Phone
(206) 329-5700
Fax
(206) 329-4894
NPI assigned
Jul 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Michelle P.M Ngo, O.DNPI 1548462419
Title
Optometrist
Phone
(206) 329-5700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2089 WA Primary

Addresses

Primary practice location

412 12TH Ave S
#205
Seattle, WA 98144-2032

Mailing address

412 12TH Ave S
#205
Seattle, WA 98144-2032
Phone (206) 329-5700

Other identifiers 1

IdentifierTypeStateIssuer
2020337MedicaidWA

Other names 1

  • Evergreen Vision Center Other name

National Provider Directory

National Provider Directory

Locations

412 12th Ave S
Ste 205
Seattle, WA 98144
Phone (206) 329-5700

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407885197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 12TH AVE S",
            "address_2": "#205",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981442032",
            "telephone_number": "206-329-5700",
            "fax_number": "206-329-4894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 12TH AVE S",
            "address_2": "#205",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981442032",
            "telephone_number": "206-329-5700",
            "fax_number": "206-329-4894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN VISION CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NGO",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "P.M",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "206-329-5700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "2089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2020337",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Vision Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Aug 22, 2020; 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.