Russell Steven Lake, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

61042825 Issued in WA

Practice address

375 Highline Dr
East Wenatchee, WA 98802-5344

Phone

(509) 886-0924

NPI assigned

Jun 10, 2020

Last updated

Jun 10, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valley Eye and Vision Clinic , PLLCGroup PAC ID 7719313790, 7 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Valley Eye and Vision Clinic PLLC

  • Optometrist
  • Moses Lake, WA
  • NPI 1881236909
  Medicare reassignment Care Compare group NPD
• Vista Optometric

  • Optometrist
  • Wenatchee, WA
  • NPI 1609554229
  NPD Authorized official
• Valley Eye and Vision Clinic , PLLC

  • Optometrist
  • East Wenatchee, WA
  • NPI 1215714852
  NPD

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

{
    "created_epoch": "1591747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1720603392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 HIGHLINE DR",
            "city": "EAST WENATCHEE",
            "state": "WA",
            "postal_code": "988025344",
            "telephone_number": "509-886-0924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 HIGHLINE DR",
            "city": "EAST WENATCHEE",
            "state": "WA",
            "postal_code": "988025344",
            "telephone_number": "509-886-0924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "RUSSELL",
        "middle_name": "STEVEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-10",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "61042825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krueger Chiropractic PLLC
• Christopher Ryan Krueger, D.C.
• Daniel Krueger, DPT
• Marla Jeanne Krueger, LMP
• Julie A Kuchtyn, C.D.
• Brittney Lynn Lamb
• Karl W Lambert, ARNP
• Debra Lapo, MD
• Carol Jean Larson, LMP/SAMP
• Paul Robert Larson, NP

• Optometrist in East Wenatchee, WA
• Providers in East Wenatchee, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.