Active NPI
Michael M. Mohandeson, M.D.
- Ophthalmology Physician
- Edmonds, WA
National Provider Identifier
1669492492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- MD00016823
- Practice address
- P.O. Box 233
Edmonds, WA 98020 - Phone
- (425) 399-6441
- Fax
- (206) 365-1118
- NPI assigned
- Jul 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | MD00016823 | WA | Primary |
Addresses
Primary practice location
P.O. Box 233
Edmonds, WA 98020
Mailing address
P.O. Box 233
Edmonds, WA 98020
Phone (206) 365-1100
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1739101 | Medicaid | WA | |
| 0017577 | Other | WA | LABOR & INDUSTRIES |
| 1932112539 | Other | NPI NUMBER FOR CORPORATION | |
| M669 | Other | WA | REGENCE BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738108800000",
"number": "1669492492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 233",
"city": "EDMONDS",
"state": "WA",
"postal_code": "98020",
"telephone_number": "206-365-1100",
"fax_number": "206-365-1118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "P.O. BOX 233",
"city": "EDMONDS",
"state": "WA",
"postal_code": "98020",
"telephone_number": "425-399-6441",
"fax_number": "206-365-1118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOHANDESON",
"first_name": "MICHAEL",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2025-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "WA",
"license": "MD00016823",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1739101",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRIES",
"identifier": "0017577",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI NUMBER FOR CORPORATION",
"identifier": "1932112539",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "M669",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edmonds, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.