Lake Forest Vision

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

OD00001793 Issued in WA

Legal business name

LAKE FOREST VISION

Practice address

17171 Bothell Way NE
Lake Forest Park, WA 98155-5534

Phone

(206) 363-9292

Fax

(206) 362-4620

NPI assigned

Dec 29, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Gary Phillip Archer, DOCTOR OF OPTOMETRYNPI 1790864205

Title

Owner

Phone

(206) 363-9292

Specialties & licenses 1

Addresses

Practitioners 1

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

• Gary Philip Archer, O.D.

  • Optometrist
  • Kirkland, WA
  • NPI 1790864205
  NPD (past) Authorized official

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710043161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17171 BOTHELL WAY NE",
            "city": "LAKE FOREST PARK",
            "state": "WA",
            "postal_code": "981555534",
            "telephone_number": "206-363-9292",
            "fax_number": "206-362-4620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17171 BOTHELL WAY NE",
            "city": "LAKE FOREST PARK",
            "state": "WA",
            "postal_code": "981555534",
            "telephone_number": "206-363-9292",
            "fax_number": "206-362-4620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE FOREST VISION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ARCHER",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "PHILLIP",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-363-9292",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DOCTOR OF OPTOMETRY"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WA",
            "license": "OD00001793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Niki Christine King
• Melinda Kloepfer Rice, ARNP
• Kelly Marie Knickerbocker, MSN ARNP PMHNP
• Lake Forest Park Acupuncture and Massage
• Lake Forest Park Clinic TR
• Daisy Abutin Lalas, NURSE CASE MANAGER
• Rebecca Carolyn Langseth
• Linda Renee Lusk-Fauquet, ARNP
• Cristina Nadine Maldonado, MSW
• Kieran Joseph McManimon, LMP

• Durable Medical Equipment & Medical Supplies in Lake Forest Park, WA
• Providers in Lake Forest Park, WA by specialty
• Durable Medical Equipment & Medical Supplies in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.