Optometry Medical Group Inc

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

OPTOMETRY MEDICAL GROUP INC

Doing business as

Optometry Medical Group

Practice address

1721 22ND Ave
Seattle, WA 98122-3324

Phone

(206) 395-2285

Fax

(206) 395-2315

NPI assigned

Sep 9, 2020

Last updated

Nov 27, 2023By 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

Mr. Huy Le Hoang, ODNPI 1932323813

Title

Director

Phone

(206) 395-2285

Specialties & licenses 1

Addresses

Other names 1

• Optometry Medical Group Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 3

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.

• Huy Le Hoang, O.D.

  • Optometrist
  • Seattle, WA
  • NPI 1932323813
  Medicare reassignment NPD Authorized official
• Jemimah Miranda Corpuz, OD

  • Optometrist
  • Seattle, WA
  • NPI 1962947978
  Medicare reassignment NPD
• Gavin Hollyer, OD

  • Optometrist
  • Seattle, WA
  • NPI 1336981679
  NPD

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

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1598370371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 22ND AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981223324",
            "telephone_number": "206-395-2285",
            "fax_number": "206-395-2315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 22ND AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981223324",
            "telephone_number": "206-395-2285",
            "fax_number": "206-395-2315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTOMETRY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-09",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-15",
        "status": "A",
        "authorized_official_last_name": "HOANG",
        "authorized_official_first_name": "HUY",
        "authorized_official_middle_name": "LE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "206-395-2285",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.optometrymedicalgroup.com/",
            "affiliation": "Y",
            "affiliationName": "JACKSON VISION CLINIC INC",
            "address_1": "225 12th Ave S Ste 103",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981441904",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Optometry Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Seattle, WA
• Providers in Seattle, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.