Everson Vision Clinic Incorporated

Primary specialty

OptometristTaxonomy code 152W00000X

License

00003776 Issued in WA

Legal business name

EVERSON VISION CLINIC INCORPORATED

Practice address

205 W Main St
Everson, WA 98247-8256

Phone

(360) 966-0445

Fax

(360) 966-0445

NPI assigned

Aug 29, 2014

Last updated

Aug 29, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alex Ilyin, ODNPI 1316039373

Title

Owner

Phone

(360) 966-0445

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Alex Ilyin, OD

  • Optometrist
  • Everson, WA
  • NPI 1316039373
  NPD (past) Authorized official

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

{
    "created_epoch": "1409270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409270400000",
    "number": "1447650189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 853",
            "city": "EVERSON",
            "state": "WA",
            "postal_code": "982470853",
            "telephone_number": "360-966-0445",
            "fax_number": "360-966-0445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 W MAIN ST",
            "city": "EVERSON",
            "state": "WA",
            "postal_code": "982478256",
            "telephone_number": "360-966-0445",
            "fax_number": "360-966-0445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERSON VISION CLINIC INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-29",
        "last_updated": "2014-08-29",
        "status": "A",
        "authorized_official_last_name": "ILYIN",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-966-0445",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "00003776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Everson, WA
• Providers in Everson, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2014; 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.