Active NPI
Phillip Keith Elliott, O.D.
- Optometrist
- Snohomish, WA
National Provider Identifier
1427097583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 872
- Practice address
- 629 Avenue D
Snohomish, WA 98290-2330 - Phone
- (360) 568-1551
- Fax
- (360) 568-9487
- NPI assigned
- Jun 5, 2006
- 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 | 872 | WA | Primary |
Addresses
Primary practice location
629 Avenue D
Snohomish, WA 98290-2330
Mailing address
PO Box 189
Snohomish, WA 98291-0189
Phone (360) 568-1551
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2254803 | Medicaid | WA |
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 |
|---|---|---|---|
| 872 | WA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1427097583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 189",
"city": "SNOHOMISH",
"state": "WA",
"postal_code": "982910189",
"telephone_number": "360-568-1551",
"fax_number": "360-568-9487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "629 AVENUE D",
"city": "SNOHOMISH",
"state": "WA",
"postal_code": "982902330",
"telephone_number": "360-568-1551",
"fax_number": "360-568-9487"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "PHILLIP",
"middle_name": "KEITH",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-05",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "872",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2254803",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Snohomish, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.