NPIMap

Organization Active NPI

Mayemura, Inc.

Doing business as Bartlett Eye Clinic

  • Optometrist
  • Bothell, WA
National Provider Identifier
1427299056
Registry record updated Mar 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MAYEMURA, INC.
Doing business as
Bartlett Eye Clinic
Practice address
14050 Juanita Dr NE
Ste. a
Bothell, WA 98011-5308
Phone
(425) 820-2020
NPI assigned
Mar 11, 2009
Last updated
Mar 26, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2009

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

Authorized official

Name
Dr. Ken Kenji Mayemura, O.D.NPI 1821131814
Title
Owner/ Optometric Physician
Phone
(425) 820-2020

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary
Corneal and Contact Management Optometrist 152WC0802X
Pediatric Optometrist 152WP0200X
Vision Therapy Optometrist 152WV0400X

Addresses

Primary practice location

14050 Juanita Dr NE
Ste. a
Bothell, WA 98011-5308

Mailing address

14050 Juanita Dr NE
Ste. a
Bothell, WA 98011-5308
Phone (425) 820-2020

Other names 1

  • Bartlett Eye Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040513001526 WA Part B Supplier - Clinic/Group Practice 8527058320 Receives reassigned benefits from 8 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Everett, WA; Kirkland, WA; Mount Lake Terrace, WA; Seattle, WA

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Bartlett Eye Clinic4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

227 Bellevue Way NE
Ste 171
Bellevue, WA 98004

14050 Juanita Dr NE
Ste A
Kirkland, WA 98034
Phone (425) 242-8974

Practitioners & affiliated clinicians

Practitioners 3

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": "1236729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238025600000",
    "number": "1427299056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14050 JUANITA DR NE",
            "address_2": "STE. A",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980115308",
            "telephone_number": "425-820-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14050 JUANITA DR NE",
            "address_2": "STE. A",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980115308",
            "telephone_number": "425-820-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYEMURA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-11",
        "last_updated": "2009-03-26",
        "status": "A",
        "authorized_official_last_name": "MAYEMURA",
        "authorized_official_first_name": "KEN",
        "authorized_official_middle_name": "KENJI",
        "authorized_official_title_or_position": "OWNER/ OPTOMETRIC PHYSICIAN",
        "authorized_official_telephone_number": "425-820-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bartlett Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bothell, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2009; 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.