NPIMap

Organization Active NPI

Benson Vision Source, Inc.

  • Optometrist
  • Kent, WA
National Provider Identifier
1679601512
Registry record updated Nov 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD00003501 Issued in WA
Legal business name
BENSON VISION SOURCE, INC.
Practice address
25022 104TH Ave SE Ste D
Kent, WA 98030-2822
Phone
(253) 859-1911
Fax
(253) 859-5084
NPI assigned
Mar 1, 2007
Last updated
Nov 26, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2012

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

Authorized official

Name
Dr. Thomas L Mitchell, O.D.NPI 1538140637
Title
President
Phone
(253) 859-1911

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OD00003501 WA Primary

Addresses

Primary practice location

25022 104TH Ave SE Ste D
Kent, WA 98030-2822

Mailing address

25022 104TH Ave SE Ste D
Kent, WA 98030-2822
Phone (253) 859-1911

National Provider Directory

National Provider Directory

Locations

25022 104th Ave SE
Kent, WA 98030
Phone (253) 852-1123

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353888000000",
    "number": "1679601512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25022 104TH AVE SE STE D",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980302822",
            "telephone_number": "253-859-1911",
            "fax_number": "253-859-5084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25022 104TH AVE SE STE D",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980302822",
            "telephone_number": "253-859-1911",
            "fax_number": "253-859-5084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENSON VISION SOURCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2012-11-26",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-859-1911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00003501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kent, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.