NPIMap

Organization Active NPI

Renton Vision Clinic PLLC

  • Optometrist
  • Renton, WA
National Provider Identifier
1457740987
Registry record updated Jan 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD60166211 Issued in WA
Legal business name
RENTON VISION CLINIC PLLC
Practice address
3218 NE 12TH St
Suite a
Renton, WA 98056-3405
Phone
(425) 228-3364
Fax
(425) 228-3378
NPI assigned
Jan 21, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2015

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

Authorized official

Name
Nasim Javaheri, O.D.NPI 1629381405
Title
Owner / Manager
Phone
(425) 228-3364

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 OD60166211 WA Primary

Addresses

Primary practice location

3218 NE 12TH St
Suite a
Renton, WA 98056-3405

Mailing address

3218 NE 12TH St
Suite a
Renton, WA 98056-3405
Phone (425) 228-3364

Other names 1

  • Renton Vision Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150216001916 WA Part B Supplier - Clinic/Group Practice 9739404757 Receives reassigned benefits from 3 practitioners
Practice locations: Renton, WA

National Provider Directory

National Provider Directory

Locations

3218 NE 12th St
Ste A
Renton, WA 98056
Phone (425) 228-3364

Practitioners & affiliated clinicians

Practitioners 4

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": "1421798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421798400000",
    "number": "1457740987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3218 NE 12TH ST",
            "address_2": "SUITE A",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980563405",
            "telephone_number": "425-228-3364",
            "fax_number": "425-228-3378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3218 NE 12TH ST",
            "address_2": "SUITE A",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980563405",
            "telephone_number": "425-228-3364",
            "fax_number": "425-228-3378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENTON VISION CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-21",
        "last_updated": "2015-01-21",
        "status": "A",
        "authorized_official_last_name": "JAVAHERI",
        "authorized_official_first_name": "NASIM",
        "authorized_official_title_or_position": "OWNER / MANAGER",
        "authorized_official_telephone_number": "425-228-3364",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60166211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renton Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Renton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; 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.