John Randall Samples

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

MD00030114 Issued in WA

Practice address

215 Lilly Rd NE
Olympia, WA 98506-5030

Phone

(360) 456-4800

Fax

(360) 456-4800

NPI assigned

May 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eye MDS of Puget Sound PLLC

  • Ophthalmology Physician
  • Tacoma, WA
  • NPI 1003858358
  Medicare reassignment NPD
• Eye MDS of Puget Sound, PLLC

  dba Narrows Optical

  • Durable Medical Equipment & Medical Supplies
  • Tacoma, WA
  • NPI 1194755611
  NPD
• The Eye Clinic PC

  • Ophthalmology Physician
  • Portland, OR
  • NPI 1639247885
  NPD
• Corneal Consultants of Colorado PC

  dba Colorado Eye Consultants

  • Ophthalmology Physician
  • Littleton, CO
  • NPI 1114910759
  NPD (past)
• Corneal Consultants of Colorado PC

  dba County Line Optical

  • Eyewear Supplier
  • Littleton, CO
  • NPI 1326032418

  Ophthalmology

  NPD (past)

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1598717860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 LILLY RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065030",
            "telephone_number": "360-456-4800",
            "fax_number": "360-456-4812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 LILLY RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065030",
            "telephone_number": "360-456-4800",
            "fax_number": "360-456-4800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11960 Lioness Way",
            "address_2": "Suite 190",
            "address_purpose": "LOCATION",
            "city": "Parker",
            "state": "CO",
            "postal_code": "80134",
            "country_code": "US",
            "telephone_number": "303-797-1900",
            "fax_number": "303-347-1341",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11960 Lioness Way",
            "address_2": "Suite 190",
            "address_purpose": "LOCATION",
            "city": "Parker",
            "state": "CO",
            "postal_code": "80134",
            "country_code": "US",
            "telephone_number": "303-797-1900",
            "fax_number": "303-347-1341",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2225 Bayside Pl NE",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985063259",
            "country_code": "US",
            "telephone_number": "303-505-0776",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMPLES",
        "first_name": "JOHN",
        "middle_name": "RANDALL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OR",
            "license": "MD 13791",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WA",
            "license": "MD00030114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "289959",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "360398",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2044175",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "180040576",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debbie Sale, AU.D.
• Emily Rae Salerno
• Heather Salisbury, MA60294771
• Denise Wood Saller, RDH,BA
• Sothear Sam, PHARMD
• Mark S Samson I, MD
• Kapuauluekekai Samuels, L.AC
• Samy's Drug Store Inc. (Samy's Drug Store)
• Elvia Aurora San Martin
• Marlene Elaine San Nicolas

• Ophthalmology Physician in Olympia, WA
• Providers in Olympia, WA by specialty
• Ophthalmology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.