Evergreen Family Eye Care, PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

EVERGREEN FAMILY EYE CARE, PLLC

Practice address

17100 State Route 507 SE
Yelm, WA 98597-7605

Phone

(360) 400-8068

Fax

(360) 400-8068

NPI assigned

Nov 13, 2018

Organization subpart

No

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

Authorized official

Name

Derek Sturtevant, OD

Title

Optometrist

Phone

(360) 400-8068

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1542067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1477022002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 6TH AVE SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985025357",
            "telephone_number": "617-645-5708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17100 STATE ROUTE 507 SE",
            "city": "YELM",
            "state": "WA",
            "postal_code": "985977605",
            "telephone_number": "360-400-8068",
            "fax_number": "360-400-8068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN FAMILY EYE CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-13",
        "last_updated": "2020-12-03",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "STURTEVANT",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "360-400-8068",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Yelm, WA
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• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; 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.