NPIMap

Organization Active NPI

Redmond Vision Clinic, PLLC

  • Optometrist
  • Redmond, WA
National Provider Identifier
1477801264
Registry record updated Jun 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
WA0004157
Legal business name
REDMOND VISION CLINIC, PLLC
Practice address
17634 NE Union Hill Rd Unit 120
Redmond, WA 98052
Phone
(425) 885-1974
Fax
(425) 882-7818
NPI assigned
Aug 27, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2018

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

Authorized official

Name
Dr. Irene Koval, ODNPI 1295934362
Title
Optometric Physician
Phone
(425) 885-1974

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 WA0004157 Primary

Addresses

Primary practice location

17634 NE Union Hill Rd Unit 120
Redmond, WA 98052

Mailing address

17634 NE Union Hill Rd Unit 120
Redmond, WA 98052-6096
Phone (425) 885-1974

Other names 1

  • Redmond 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
O20121101000021 WA Part B Supplier - Clinic/Group Practice 0143470963 Receives reassigned benefits from 2 practitioners
Practice locations: Redmond, WA

National Provider Directory

National Provider Directory

Locations

17634 NE Union Hill Rd
Unit 120
Redmond, WA 98052
Phone (425) 885-1974

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": "1346025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529884800000",
    "number": "1477801264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17634 NE UNION HILL RD UNIT 120",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "980526096",
            "telephone_number": "425-885-1974",
            "fax_number": "425-882-7818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17634 NE UNION HILL RD UNIT 120",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "98052",
            "telephone_number": "425-885-1974",
            "fax_number": "425-882-7818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDMOND VISION CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-27",
        "last_updated": "2018-06-25",
        "status": "A",
        "authorized_official_last_name": "KOVAL",
        "authorized_official_first_name": "IRENE",
        "authorized_official_title_or_position": "OPTOMETRIC PHYSICIAN",
        "authorized_official_telephone_number": "425-885-1974",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": "WA0004157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Redmond Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Redmond Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Redmond, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; 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.