Individual provider Active NPI

Nasim Javaheri, OD

  • Optometrist
  • Renton, WA
National Provider Identifier
1629381405
Registry record updated Dec 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD60166211 Issued in WA
Practice address
3218 NE 12TH St
Suite a
Renton, WA 98056-3405
Phone
(425) 228-3364
Fax
(425) 228-3378
NPI assigned
Jul 21, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD60166211 WA Primary

Addresses

Primary practice location

3218 NE 12TH St
Suite a
Renton, WA 98056-3405

Mailing address

3218 NE 12TH St
Suite a
Renton, WA 98056-3405
Phone (425) 228-3364

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20110126001068 WA Practitioner - Optometry 9436338191 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Issaquah Vision Center PLLCGroup PAC ID 3577822907, 2 clinicians
Renton Vision Clinic PLLCGroup PAC ID 9739404757, 2 clinicians

Practice addresses (Care Compare)

1460 NW Gilman Blvd
Suite K2
Issaquah, WA 98027-5300
Phone (425) 654-3652

3218 NE 12TH St
Suite a
Renton, WA 98056-3405
Phone (425) 228-3364

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Issaquah Vision Center PLLC Optometrist CurrentSince Oct 19, 2017 Accepting new patients
Renton Vision Clinic PLLC Optometrist CurrentSince Dec 8, 2014 Accepting new patients
Bella Vision Corporation PastSince Apr 12, 2009 Accepting new patients

Locations

1460 NW Gilman Blvd
Ste K2
Issaquah, WA 98027
Phone (425) 654-3652

3218 NE 12th St
Ste A
Renton, WA 98056
Phone (425) 228-3364

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1279670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417651200000",
    "number": "1629381405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3218 NE 12TH ST",
            "address_2": "SUITE A",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980563405",
            "telephone_number": "425-228-3364",
            "fax_number": "425-228-3378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3218 NE 12TH ST",
            "address_2": "SUITE A",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980563405",
            "telephone_number": "425-228-3364",
            "fax_number": "425-228-3378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAVAHERI",
        "first_name": "NASIM",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-21",
        "last_updated": "2014-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60166211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

Verify at the official NPI Registry.