NPIMap

Individual provider Active NPI

Michael E Mockovak, MD

  • Optometrist
  • Vancouver, WA
National Provider Identifier
1710108196
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
MD26938 Issued in WA
Practice address
1325 SE Tech Center Dr
Suite 110
Vancouver, WA 98683-5552
Phone
(360) 635-5000
Fax
(360) 635-5001
NPI assigned
May 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X MD26938 WA Primary

Addresses

Primary practice location

1325 SE Tech Center Dr
Suite 110
Vancouver, WA 98683-5552

Mailing address

900 SW 16TH St
Suite 320
Renton, WA 98055-2631
Phone (360) 635-5000

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)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD26938WAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Clearly Lasik, Inc. Past Accepting new patients
Meister Eye & Laser Center, a Medical Group, Inc. Past Accepting new patients
Clearly Lasik Optometrist Past Accepting new patients

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": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1710108196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 SW 16TH ST",
            "address_2": "SUITE 320",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980552631",
            "telephone_number": "360-635-5000",
            "fax_number": "360-635-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 SE TECH CENTER DR",
            "address_2": "SUITE 110",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986835552",
            "telephone_number": "360-635-5000",
            "fax_number": "360-635-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOCKOVAK",
        "first_name": "MICHAEL",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "MD26938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.