NPIMap

Organization Active NPI

Apple Valley Optometry PC

  • Optometrist
  • Yakima, WA
National Provider Identifier
1689175036
Registry record updated Feb 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
60728167 Issued in WA
Legal business name
APPLE VALLEY OPTOMETRY PC
Practice address
1121 S 40TH Ave
Yakima, WA 98908-3930
Phone
(509) 966-8801
Fax
(509) 965-9804
NPI assigned
Feb 21, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2018

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

Authorized official

Name
Jason Mark Larsen, ODNPI 1407895964
Title
Optometrist/Owner
Phone
(509) 966-8801

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 60728167 WA Primary

Addresses

Primary practice location

1121 S 40TH Ave
Yakima, WA 98908-3930

Mailing address

1121 S 40TH Ave
Yakima, WA 98908-3930
Phone (509) 966-8801

Other names 1

  • Apple Valley Eye Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180426002930 WA Part B Supplier - Clinic/Group Practice 1951665942 Receives reassigned benefits from 3 practitioners
Practice locations: Yakima, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1519171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519171200000",
    "number": "1689175036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 S 40TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083930",
            "telephone_number": "509-966-8801",
            "fax_number": "509-965-9804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 S 40TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083930",
            "telephone_number": "509-966-8801",
            "fax_number": "509-965-9804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APPLE VALLEY OPTOMETRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-21",
        "last_updated": "2018-02-21",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "509-966-8801",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "60728167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Apple Valley Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yakima, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.