NPIMap

Organization Active NPI

Ron Coverdale OD PS

  • Optometrist
  • Kenmore, WA
National Provider Identifier
1437331782
Registry record updated Mar 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD00000895 Issued in WA
Legal business name
RON COVERDALE OD PS
Practice address
6830 NE Bothell Way
Suite B
Kenmore, WA 98028-3546
Phone
(425) 485-3051
Fax
(425) 482-2441
NPI assigned
Nov 28, 2007
Last updated
Mar 9, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2010

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

Authorized official

Name
Dr. Charles Ron Coverdale, ODNPI 1194812404
Title
President
Phone
(425) 485-3051

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OD00000895 WA Primary

Addresses

Primary practice location

6830 NE Bothell Way
Suite B
Kenmore, WA 98028-3546

Mailing address

6830 NE Bothell Way
Suite B
Kenmore, WA 98028-3546
Phone (425) 485-3051

National Provider Directory

National Provider Directory

Locations

6830 NE Bothell Way
Kenmore, WA 98028
Phone (425) 485-3051

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": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268092800000",
    "number": "1437331782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6830 NE BOTHELL WAY",
            "address_2": "SUITE B",
            "city": "KENMORE",
            "state": "WA",
            "postal_code": "980283546",
            "telephone_number": "425-485-3051",
            "fax_number": "425-482-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6830 NE BOTHELL WAY",
            "address_2": "SUITE B",
            "city": "KENMORE",
            "state": "WA",
            "postal_code": "980283546",
            "telephone_number": "425-485-3051",
            "fax_number": "425-482-2441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RON COVERDALE OD PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-28",
        "last_updated": "2010-03-09",
        "status": "A",
        "authorized_official_last_name": "COVERDALE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "RON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "425-485-3051",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00000895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenmore, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2010; 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.