Jeffrey Bernard Sutro, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1909TX Issued in WA

Practice address

5017 196TH St SW
Suite 204
Lynnwood, WA 98036-6123

Phone

(425) 778-1588

Fax

(425) 778-2523

NPI assigned

Jul 5, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jeff.sutro@70976835354628.direct.elationemr.com
• FHIR API: https://api.platform.athenahealth.com/25713/brand/1/csg/1/fhir/r4

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.

• Endomed Family Clinic LLC

  • Family Nurse Practitioner
  • Lynnwood, WA
  • NPI 1891456281
  NPD (past)

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262736000000",
    "number": "1619974771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5017 196TH ST SW",
            "address_2": "SUITE 204",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366123",
            "telephone_number": "425-778-1588",
            "fax_number": "425-778-2523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5017 196TH ST SW",
            "address_2": "SUITE 204",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366123",
            "telephone_number": "425-778-1588",
            "fax_number": "425-778-2523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTRO",
        "first_name": "JEFFREY",
        "middle_name": "BERNARD",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2010-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "1909TX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2011963",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Izabella Surenyants
• Jyoti Suri, BCBA, LBA
• Daniel Susanto, MD
• Maureen Sutcliffe, LMP, CMT
• Nancy N Sutherland, RN, MED.
• Meghan Sutton
• Erin Elizabeth Swan, MSW
• Mariah S Swan
• Wendy L Swanberg Conaway, LMP
• Sally Jay Swanberg, CDP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2010; 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.