Woodlawn Optical of Bothell,Inc

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

DO 00001478 Issued in WA

Legal business name

WOODLAWN OPTICAL OF BOTHELL,INC

Practice address

10116 Main St
Suite 102
Bothell, WA 98011-3444

Phone

(425) 486-7270

Fax

(425) 481-7291

NPI assigned

Sep 18, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Paul Joseph Kavanagh, LDO

Title

President

Phone

(425) 486-7270

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195776000000",
    "number": "1609062298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10116 MAIN ST",
            "address_2": "SUITE 102",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980113444",
            "telephone_number": "425-486-7270",
            "fax_number": "425-481-7291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10116 MAIN ST",
            "address_2": "SUITE 102",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980113444",
            "telephone_number": "425-486-7270",
            "fax_number": "425-481-7291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODLAWN OPTICAL OF BOTHELL,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-18",
        "last_updated": "2007-11-23",
        "status": "A",
        "authorized_official_last_name": "KAVANAGH",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "425-486-7270",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LDO"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "WA",
            "license": "DO 00001478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2081206",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Beth Woll, RC
• Kerlan Peter Wolsey, M.D.
• Jessica Womack, OTD
• Hiu Nam Wong
• Wing Ho Wong, DC
• Isaac Gabriel Wordsworth, LMT
• Pauline Fatyga Wray, LICSW
• Nicholas Wright
• Victoria E Wright
• Cecilia Wu

• Eyewear Supplier in Bothell, WA
• Providers in Bothell, WA by specialty
• Eyewear Supplier in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.