NPIMap

Organization Active NPI

Edmonds Eyecare Associates Inc PS

  • Optometrist
  • Edmonds, WA
National Provider Identifier
1558451369
Registry record updated Jun 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1736TX Issued in WA
Legal business name
EDMONDS EYECARE ASSOCIATES INC PS
Practice address
7315 212TH St SW
Suite 200
Edmonds, WA 98026-7610
Phone
(425) 774-2020
Fax
(425) 670-8932
NPI assigned
Oct 13, 2006
Last updated
Jun 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2014

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

Authorized official

Name
Dr. Glen R Owen, O.D.NPI 1174613715
Title
Owner
Phone
(425) 774-2020

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 MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 1736TX WA Primary

Addresses

Primary practice location

7315 212TH St SW
Suite 200
Edmonds, WA 98026-7610

Mailing address

7315 212TH St SW
Suite 200
Edmonds, WA 98026-7610
Phone (425) 774-2020

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040315000494 WA Part B Supplier - Clinic/Group Practice 6103715370 Receives reassigned benefits from 4 practitioners
Practice locations: Edmonds, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402358400000",
    "number": "1558451369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7315 212TH ST SW",
            "address_2": "SUITE 200",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267610",
            "telephone_number": "425-774-2020",
            "fax_number": "425-670-8932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7315 212TH ST SW",
            "address_2": "SUITE 200",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267610",
            "telephone_number": "425-774-2020",
            "fax_number": "425-670-8932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDMONDS EYECARE ASSOCIATES INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2014-06-10",
        "status": "A",
        "authorized_official_last_name": "OWEN",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-774-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "1736TX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmonds, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2014; 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.