Active NPI
Patrick Eugene Davidson, OD
- Optometrist
- Lynnwood, WA
National Provider Identifier
1720068604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- WA3149
- Practice address
- 18411-A Alderwood Mall Pkwy
Lynnwood, WA 98037 - Phone
- (425) 771-8472
- Fax
- (425) 672-8943
- NPI assigned
- Jan 18, 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | WA3149 | WA | Primary |
Addresses
Primary practice location
18411-A Alderwood Mall Pkwy
Lynnwood, WA 98037
Mailing address
18411-A Alderwood Mall Pkwy
Lynnwood, WA 98037
Phone (425) 771-8472
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2024552 | Medicaid | WA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| WA3149 | WA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263427200000",
"number": "1720068604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18411-A ALDERWOOD MALL PKWY",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "98037",
"telephone_number": "425-771-8472",
"fax_number": "425-672-8943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18411-A ALDERWOOD MALL PKWY",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "98037",
"telephone_number": "425-771-8472",
"fax_number": "425-672-8943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDSON",
"first_name": "PATRICK",
"middle_name": "EUGENE",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-18",
"last_updated": "2010-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "WA3149",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2024552",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.