Optical Shop of Wa Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

3108 Issued in WA

Legal business name

OPTICAL SHOP OF WA INC

Practice address

1635 Olympic Hwy N
Suite 102
Shelton, WA 98584-3065

Phone

(360) 427-7553

Fax

(360) 426-2033

NPI assigned

Dec 17, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Dolores Mae Fraire, ODNPI 1033103221

Title

Optometrist

Phone

(360) 427-7553

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dolores Mae Fraire, OD

  • Optometrist
  • Shelton, WA
  • NPI 1033103221
  Medicare reassignment Authorized official
• Joseph J Zelasko, O.D.

  • Optometrist
  • Tacoma, WA
  • NPI 1548301617
  NPD (past)

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

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470096000000",
    "number": "1730362435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 OLYMPIC HWY N",
            "address_2": "SUITE 102",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985843065",
            "telephone_number": "360-427-7553",
            "fax_number": "360-426-2033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 OLYMPIC HWY N",
            "address_2": "SUITE 102",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985843065",
            "telephone_number": "360-427-7553",
            "fax_number": "360-426-2033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICAL SHOP OF WA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-17",
        "last_updated": "2016-08-02",
        "status": "A",
        "authorized_official_last_name": "FRAIRE",
        "authorized_official_first_name": "DOLORES",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "360-427-7553",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "3108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olympic Physicians P.L.L.C.
• Olympic Physicians P.L.L.C.
• Olympic Physicians P.L.L.C.
• Olympic Physicians, PLLC
• Olympic Surgical Services, P.L.L.C.
• Lora Osborne
• Medina Othman Glenn, PA
• Jack Lynn Ott, RPH
• Jared Preston Outen
• Joel Owens

• Optometrist in Shelton, WA
• Providers in Shelton, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2016; 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.