Maple Valley Vision Clinic PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

WA1115TX Issued in WA

Legal business name

MAPLE VALLEY VISION CLINIC PLLC

Doing business as

Maple Valley Vision Clinic

Practice address

23714 222ND PL SE Ste B
Maple Valley, WA 98038

Phone

(425) 432-1206

Fax

(425) 413-4465

NPI assigned

Aug 18, 2006

Last updated

Jul 31, 2018By 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

Scott W. Bennion, O.D.NPI 1780656660

Title

Member/Manager

Phone

(425) 432-1206

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Maple Valley Vision Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 5

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.

• Scott W Bennion, OD

  • Optometrist
  • Maple Valley, WA
  • NPI 1780656660
  Medicare reassignment NPD Authorized official
• Ryan Scott Bennion, O.D.

  • Optometrist
  • St George, UT
  • NPI 1235154956

  WA

  Medicare reassignment NPD
• Marienne Alyssa Santa Elena, OD

  • Optometrist
  • Maple Valley, WA
  • NPI 1851083281
  NPD
• Joshua Aaron Rigtrup

  • Hearing Instrument Specialist
  • Maple Valley, WA
  • NPI 1508075136
  NPD (past)
• Jennifer Helen Bennett, BC-HIS

  • Hearing Instrument Specialist
  • St George, UT
  • NPI 1598046856
  NPD (past)

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532995200000",
    "number": "1558475558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23714 222ND PL SE STE B",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980385800",
            "telephone_number": "425-432-1206",
            "fax_number": "425-413-4465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23714 222ND PL SE STE B",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "98038",
            "telephone_number": "425-432-1206",
            "fax_number": "425-413-4465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE VALLEY VISION CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2018-07-31",
        "status": "A",
        "authorized_official_last_name": "BENNION",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "authorized_official_telephone_number": "425-432-1206",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "WA1115TX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2032050",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Valley Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Maple Valley Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maple Valley Dentistry Professionals
• Maple Valley Eye Care Center PS
• Maple Valley Hearing AIDS LLC
• Maple Valley Movement Neurology, PLLC
• Maple Valley Physical Therapy, Inc.
• George M. Marchis, D.P.T.
• Shannon Lynn Markegard, DO
• Brenda Martinez
• Haifa M Marzouqa, PHARMACIST
• Kendall Mathew, LMP

• Optometrist in Maple Valley, WA
• Providers in Maple Valley, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.